MEDICARE: THERESA MARIE CUSTODIO FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP2300X	Primary Care Nurse Practitioner	84185	NM

General Provider Information

NPI Number	:	1093609562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESA MARIE CUSTODIO FNP

Provider Business Mailing Address
First Line	:	PO BOX 27561
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87125-7561
Country	:	US
Telephone Number	:	505-873-7405
Fax Number	:

Provider Business Practice Location Address
First Line	:	2001 CENTRO FAMILIAR BLVD SW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87105-4592
Country	:	US
Telephone Number	:	505-873-7400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2025
Last Update Date	:	03/16/2026

Similar Medicare Providers

1215525902 — AUGUST VOJDANI PA-C
Practice Location Address:

4588 PARADISE BLVD NW , MEDICARE ADVANTAGE CLINIC
ALBUQUERQUE, NM
87114-4105

Practice Phone: 505-998-1840
Practice Fax: 505-998-1841

1336807205 — LIVIA DEL TORO GARCIA
Practice Location Address:

2001 CENTRO FAMILIAR BLVD SW
ALBUQUERQUE, NM
87105-4592

Practice Phone: 505-873-7400
Practice Fax:

1073075065 — JARON KEE MD
Practice Location Address:

2001 CENTRO FAMILIAR BLVD SW
ALBUQUERQUE, NM
87105-4592

Practice Phone: 505-873-7400
Practice Fax:

1003310053 — ERIN O'NEAL
Practice Location Address:

2001 CENTRO FAMILIAR BLVD SW
ALBUQUERQUE, NM
87105-4592

Practice Phone: 505-873-7400
Practice Fax:

1821944406 — KIMBERLY HOLYFIELD
Practice Location Address:

2001 CENTRO FAMILIAR BLVD SW STE B
ALBUQUERQUE, NM
87105-4592

Practice Phone: 505-272-5786
Practice Fax:

1154328094 — SANTIAGO R. MACIAS MD
Practice Location Address:

2001 EL CENTRO FAMILIAR BLVD SW
ALBUQUERQUE, NM
87105-4592

Practice Phone: 505-873-7400
Practice Fax:

Directions to “ THERESA MARIE CUSTODIO FNP” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.