Healthcare Provider Details

I. General information

NPI: 1396282083
Provider Name (Legal Business Name): THERESA KEEFER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2017
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 MEADOW TRL
CANTONMENT FL
32533-2610
US

IV. Provider business mailing address

1201 MEADOW TRL
CANTONMENT FL
32533-2610
US

V. Phone/Fax

Practice location:
  • Phone: 850-380-9682
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP 9245326
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2025037514
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number218969
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: