Provider Demographics
NPI:1215267331
Name:GROOVER, THERESA JANE (CFA)
Entity type:Individual
Prefix:MS
First Name:THERESA
Middle Name:JANE
Last Name:GROOVER
Suffix:
Gender:F
Credentials:CFA
Other - Prefix:MS
Other - First Name:THERESA
Other - Middle Name:JANE
Other - Last Name:WURSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CFA
Mailing Address - Street 1:1531 DREXEL RD
Mailing Address - Street 2:APT 191
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33417-4235
Mailing Address - Country:US
Mailing Address - Phone:561-707-8556
Mailing Address - Fax:
Practice Address - Street 1:1531 DREXEL RD
Practice Address - Street 2:APT 191
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33417-4235
Practice Address - Country:US
Practice Address - Phone:561-707-8556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLGFL635361246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant