Provider Demographics
NPI:1750444089
Name:CHARLESWORTH, TERESA LOUISE (RNC, MSN, FNP)
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:LOUISE
Last Name:CHARLESWORTH
Suffix:
Gender:F
Credentials:RNC, MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6888 LEILANI LN
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-5718
Mailing Address - Country:US
Mailing Address - Phone:714-657-0657
Mailing Address - Fax:714-657-0657
Practice Address - Street 1:1400 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-2321
Practice Address - Country:US
Practice Address - Phone:714-541-6815
Practice Address - Fax:714-541-8032
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA429304163W00000X
CA10422363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
P40098Medicare UPIN