Provider Demographics
NPI:1760033146
Name:RAK, THERESA ROSE (APRN-FNP)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:ROSE
Last Name:RAK
Suffix:
Gender:F
Credentials:APRN-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2960 HAYES ST
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-2132
Mailing Address - Country:US
Mailing Address - Phone:440-258-2487
Mailing Address - Fax:
Practice Address - Street 1:1997 HEALTHWAY DR
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011-2834
Practice Address - Country:US
Practice Address - Phone:440-988-6660
Practice Address - Fax:440-988-6661
Is Sole Proprietor?:No
Enumeration Date:2019-09-26
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.025660363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily