Provider Demographics
NPI:1972564060
Name:HALM, THERESA (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:
Last Name:HALM
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3466 N HARBOR CITY BLVD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-5713
Mailing Address - Country:US
Mailing Address - Phone:321-434-1981
Mailing Address - Fax:321-434-5862
Practice Address - Street 1:255 BORMAN DR
Practice Address - Street 2:2ND FLOOR
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-3486
Practice Address - Country:US
Practice Address - Phone:321-434-1640
Practice Address - Fax:321-434-5862
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1265562363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner