Basic Information
| Provider Information | |||||||||
| NPI: | 1699779439 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HULME | ||||||||
| FirstName: | THERESE | ||||||||
| MiddleName: | M. | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14499 N DALE MABRY HWY | ||||||||
| Address2: | STE 180-S | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336182078 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8133742406 | ||||||||
| FaxNumber: | 8133742407 | ||||||||
| Practice Location | |||||||||
| Address1: | 1839 CENTRAL AVENUE | ||||||||
| Address2: | |||||||||
| City: | ST. PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7273221054 | ||||||||
| FaxNumber: | 7273222725 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2005 | ||||||||
| LastUpdateDate: | 08/18/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | ARNP 1738562 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | P00115550 | 01 | FL | RAIL ROAD MEDICARE | OTHER | 301847400 | 05 | FL | MEDICAID |