Individual
THERESA MARIE BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
402 N BABCOCK ST STE 102, MELBOURNE, FL 32935-7335
(321) 241-6540
(321) 428-4442
Mailing address
PO BOX 361095, MELBOURNE, FL 32936-1095
(321) 253-2900
(321) 435-0100
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
APRN11025876
FL
Other
Enumeration date
04/19/2023
Last updated
04/19/2023
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