Provider Demographics
NPI:1194314005
Name:REPKO, THERESA ANNE (FNP-C)
Entity type:Individual
Prefix:MS
First Name:THERESA
Middle Name:ANNE
Last Name:REPKO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 KOLBE RD STE 205
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-1677
Mailing Address - Country:US
Mailing Address - Phone:440-989-1800
Mailing Address - Fax:440-989-1801
Practice Address - Street 1:3600 KOLBE RD STE 205
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-1677
Practice Address - Country:US
Practice Address - Phone:440-989-1800
Practice Address - Fax:440-989-1801
Is Sole Proprietor?:No
Enumeration Date:2021-01-14
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0028154363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily