Healthcare Provider Details

I. General information

NPI: 1164408233
Provider Name (Legal Business Name): THERESA W DRYDEN ANP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: THERESA W HARDIN ANP-C

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 02/13/2026
Certification Date: 02/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

449621 US HIGHWAY 301 STE 110
CALLAHAN FL
32011-9348
US

IV. Provider business mailing address

6101 BLUE LAGOON DR STE 200
MIAMI FL
33126-3168
US

V. Phone/Fax

Practice location:
  • Phone: 904-507-2692
  • Fax: 904-507-2693
Mailing address:
  • Phone: 305-500-2000
  • Fax: 305-500-2155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number11001549
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: