Provider Demographics
NPI:1194165100
Name:WILMOTH, TERESA L (ARNP)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:L
Last Name:WILMOTH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:L
Other - Last Name:CHEESMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:300 PARKVIEW PL
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-4550
Mailing Address - Country:US
Mailing Address - Phone:863-687-1300
Mailing Address - Fax:863-687-1305
Practice Address - Street 1:300 PARKVIEW PL
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-4550
Practice Address - Country:US
Practice Address - Phone:863-687-1300
Practice Address - Fax:863-687-1305
Is Sole Proprietor?:No
Enumeration Date:2013-07-05
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN2757772363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health