Provider Demographics
NPI:1881947760
Name:ECKERT, THERESA MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:MARIE
Last Name:ECKERT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6885 BELFORT OAKS PL STE 110
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-6281
Mailing Address - Country:US
Mailing Address - Phone:904-652-0373
Mailing Address - Fax:
Practice Address - Street 1:6885 BELFORT OAKS PL STE 110
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-6281
Practice Address - Country:US
Practice Address - Phone:904-652-0373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-17
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9106914363A00000X
VA0110005544363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant