Provider Demographics
NPI:1851005680
Name:COBBS, THERESA
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:COBBS
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 1:11048 SNOWBROOK CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32221-4938
Mailing Address - Country:US
Mailing Address - Phone:904-250-1140
Mailing Address - Fax:877-310-9005
Practice Address - Street 1:11048 SNOWBROOK CT
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32221-4938
Practice Address - Country:US
Practice Address - Phone:904-250-1140
Practice Address - Fax:877-310-9005
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-06
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23070251C00000X, 3747A0650X, 106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician