MEDICARE: MRS. THERESA PYE ARNP

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	ARNP1060292	FL

General Provider Information

NPI Number	:	1487776647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. THERESA PYE ARNP

Provider Business Mailing Address
First Line	:	3148 BROUGHAM AVE
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32246-1203
Country	:	US
Telephone Number	:	904-223-4855
Fax Number	:

Provider Business Practice Location Address
First Line	:	3872 SAN JOSE PARK DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-4613
Country	:	US
Telephone Number	:	904-482-0313
Fax Number	:

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

Provider Enumeration Date	:	04/06/2007
Last Update Date	:	07/08/2007

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