Provider Demographics
NPI:1821713561
Name:CULHANE, TESSA
Entity Type:Individual
Prefix:
First Name:TESSA
Middle Name:
Last Name:CULHANE
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 1:11921 PLANTATION RD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33966-1344
Mailing Address - Country:US
Mailing Address - Phone:239-269-5765
Mailing Address - Fax:
Practice Address - Street 1:11921 PLANTATION RD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33966-1344
Practice Address - Country:US
Practice Address - Phone:239-269-5765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP457234183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist