Provider Demographics
NPI:1831697853
Name:DAMERA, TERESA DE JESUS
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:DE JESUS
Last Name:DAMERA
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 1:2665 CLEVELAND AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-5850
Mailing Address - Country:US
Mailing Address - Phone:239-839-1950
Mailing Address - Fax:239-236-1665
Practice Address - Street 1:2665 CLEVELAND AVE STE 208
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-5850
Practice Address - Country:US
Practice Address - Phone:239-839-1950
Practice Address - Fax:239-236-1665
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-24
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11004588363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care