Healthcare Provider Details

I. General information

NPI: 1760033146
Provider Name (Legal Business Name): THERESA ROSE RAK APRN-FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2019
Last Update Date: 08/20/2020
Certification Date: 08/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1997 HEALTHWAY DR
AVON OH
44011-2834
US

IV. Provider business mailing address

2960 HAYES ST
AVON OH
44011-2132
US

V. Phone/Fax

Practice location:
  • Phone: 440-988-6660
  • Fax: 440-988-6661
Mailing address:
  • Phone: 440-258-2487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.025660
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: