Healthcare Provider Details

I. General information

NPI: 1508348111
Provider Name (Legal Business Name): THERESA LYNN HESS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2018
Last Update Date: 08/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3697 LAKE EMMA RD STE 126
LAKE MARY FL
32746-6121
US

IV. Provider business mailing address

3697 LAKE EMMA RD STE 126
LAKE MARY FL
32746-6121
US

V. Phone/Fax

Practice location:
  • Phone: 407-506-2999
  • Fax:
Mailing address:
  • Phone: 407-506-2999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number9271628
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: