Provider Demographics
NPI:1871552604
Name:DURANT, THERESA (RN)
Entity type:Individual
Prefix:MS
First Name:THERESA
Middle Name:
Last Name:DURANT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4403 W ESTRELLA ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-5513
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13000 BRUCE B. DOWNS BLVD
Practice Address - Street 2:JAMES A. HALEY VA HOSPITAL, S
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-4799
Practice Address - Country:US
Practice Address - Phone:813-972-2000
Practice Address - Fax:813-978-5913
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3113952163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse