Provider Demographics
NPI:1821456195
Name:ELDRIDGE, TERESA
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:ELDRIDGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 QUAIL DR
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-4674
Mailing Address - Country:US
Mailing Address - Phone:321-557-5017
Mailing Address - Fax:321-452-1385
Practice Address - Street 1:300 QUAIL DR
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-4674
Practice Address - Country:US
Practice Address - Phone:321-557-5017
Practice Address - Fax:321-452-1385
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-02
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care