Healthcare Provider Details

I. General information

NPI: 1548715113
Provider Name (Legal Business Name): TERESA DE JESUS FLORES FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TERESA DE JESUS BONILLA

II. Dates (important events)

Enumeration Date: 08/23/2016
Last Update Date: 06/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 OAKBROOK PKWY SUITE 130
NORCROSS GA
30093-2256
US

IV. Provider business mailing address

5300 OAKBROOK PKWY SUITE 130
NORCROSS GA
30093-2256
US

V. Phone/Fax

Practice location:
  • Phone: 770-279-3141
  • Fax:
Mailing address:
  • Phone: 770-279-3141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SC1501X
TaxonomyCommunity Health/Public Health Clinical Nurse Specialist
License NumberRN181497
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License NumberRN181497
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN181497
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: