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General NPI Number Information
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NPI Number | 1154881027
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Entity Type | Individual
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Provider Name | THERESA LUPE MSN, PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 03/25/2019
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Last Update Date | 03/25/2019
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Provider Practice Location Address
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Address Line | 7000 H C KELLEY RD
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City | ORLANDO
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State | FL
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Zip | 32831-2521
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Country | US
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Telephone | 407-207-7777
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Fax |
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Provider Business Mailing Address
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Address Line | 2230 MICHIGAN ST
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City | MELBOURNE
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State | FL
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Zip | 32904-6131
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Country | US
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Telephone | 321-271-0503
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN11001232
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License Number State | FL
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