Individual
JANEEN M THEOBALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
12902 USF MAGNOLIA DR, TAMPA, FL 33612
(813) 745-4673
Mailing address
1442 HARBOUR WALK RD, TAMPA, FL 33602-5971
(321) 626-2111
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
ARNP3359822
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
014258500
—
FL
01
—
P01655871
RAILROAD MCR
FL
01
—
Y0R2X
BCBS
FL
Enumeration date
02/02/2015
Last updated
05/18/2018
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