Provider Demographics
NPI:1922373711
Name:LONDON, THERESA L (RN)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:L
Last Name:LONDON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10227 CLASSIC OAK RD N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-9032
Mailing Address - Country:US
Mailing Address - Phone:904-504-5502
Mailing Address - Fax:
Practice Address - Street 1:10227 CLASSIC OAK RD N
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-9032
Practice Address - Country:US
Practice Address - Phone:904-504-5502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2945332163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse