Provider Demographics
NPI:1750831988
Name:SMITH, TERESA ANNE (ACNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:ANNE
Last Name:SMITH
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5923 BRIDLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-1008
Mailing Address - Country:US
Mailing Address - Phone:419-349-8530
Mailing Address - Fax:
Practice Address - Street 1:5923 BRIDLEWOOD DR
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-1008
Practice Address - Country:US
Practice Address - Phone:419-349-8530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA05719NP363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care