Provider Demographics
NPI:1447845888
Name:PROCTOR, THERESA VICTORIA (DNP, FNP-C)
Entity type:Individual
Prefix:DR
First Name:THERESA
Middle Name:VICTORIA
Last Name:PROCTOR
Suffix:
Gender:F
Credentials:DNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 NEWBURG AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-5172
Mailing Address - Country:US
Mailing Address - Phone:443-207-0733
Mailing Address - Fax:
Practice Address - Street 1:11 NEWBURG AVE STE 3
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-5172
Practice Address - Country:US
Practice Address - Phone:443-207-0733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-08
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDF01210028363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily