Provider Demographics
NPI:1215674759
Name:KUNNUMMEL, THRESIAMMA
Entity type:Individual
Prefix:
First Name:THRESIAMMA
Middle Name:
Last Name:KUNNUMMEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:THRESIAMMA
Other - Middle Name:
Other - Last Name:KUNNUMMEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1124 85TH TER N APT D
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-3315
Mailing Address - Country:US
Mailing Address - Phone:727-599-4512
Mailing Address - Fax:
Practice Address - Street 1:1200 7TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-1300
Practice Address - Country:US
Practice Address - Phone:727-825-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-17
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9340350163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse