Provider Demographics
NPI:1740730373
Name:LINO, TERESA
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:LINO
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 1:8736 SABAL WAY
Mailing Address - Street 2:
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668-5527
Mailing Address - Country:US
Mailing Address - Phone:727-485-6045
Mailing Address - Fax:
Practice Address - Street 1:8736 SABAL WAY
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-5527
Practice Address - Country:US
Practice Address - Phone:727-485-6045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-06
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker