MEDICARE: THERESA R O'DONNELL APNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	ARNP9306821	FL
2	363LF0000X	Family Nurse Practitioner	SP014731	PA
3	363LF0000X	Family Nurse Practitioner	7146	WI

General Provider Information

NPI Number	:	1396009858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESA R O'DONNELL APNP

Provider Business Mailing Address
First Line	:	2221 NE 33RD AVE
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33305-1844
Country	:	US
Telephone Number	:	305-799-7669
Fax Number	:

Provider Business Practice Location Address
First Line	:	2221 NE 33RD AVE
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33305-1844
Country	:	US
Telephone Number	:	305-799-7669
Fax Number	:	267-573-3198

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2012
Last Update Date	:	12/09/2025

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