Healthcare Provider Details

I. General information

NPI: 1336288679
Provider Name (Legal Business Name): TERESA H MCCORMICK CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TERESA ANNE MCCORMICK CRNA

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6101 PINE RIDGE RD
NAPLES FL
34119-3900
US

IV. Provider business mailing address

1301 SOLANA BLVD STE 2200
WESTLAKE TX
76262-1769
US

V. Phone/Fax

Practice location:
  • Phone: 239-304-4716
  • Fax:
Mailing address:
  • Phone: 610-716-1385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN293519L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN9470120
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: