Provider Demographics
NPI:1932653920
Name:LAURENTE, THERESA MARIE (FNP)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:MARIE
Last Name:LAURENTE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:THERESA
Other - Last Name:GELOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:4710 N HABANA AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-7151
Mailing Address - Country:US
Mailing Address - Phone:813-873-1016
Mailing Address - Fax:813-874-2813
Practice Address - Street 1:4710 N HABANA AVE STE 300
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-7151
Practice Address - Country:US
Practice Address - Phone:813-873-1016
Practice Address - Fax:813-874-2813
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-08
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95004603363LF0000X
FL9264424363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily