Provider Demographics
NPI:1548715113
Name:FLORES, TERESA DE JESUS (FNP)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:DE JESUS
Last Name:FLORES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:DE JESUS
Other - Last Name:BONILLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5300 OAKBROOK PKWY
Mailing Address - Street 2:SUITE 130
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-2256
Mailing Address - Country:US
Mailing Address - Phone:770-279-3141
Mailing Address - Fax:
Practice Address - Street 1:5300 OAKBROOK PKWY
Practice Address - Street 2:SUITE 130
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-2256
Practice Address - Country:US
Practice Address - Phone:770-279-3141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-23
Last Update Date:2017-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN181497364SC1501X, 364SF0001X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SC1501XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCommunity Health/Public Health
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health