Provider Demographics
NPI:1972577765
Name:HEDDEN, TERESA (CRNA)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:HEDDEN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6660 ESTERO BLVD
Mailing Address - Street 2:#701B
Mailing Address - City:FORT MYERS BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33931-4567
Mailing Address - Country:US
Mailing Address - Phone:239-939-2622
Mailing Address - Fax:239-939-0151
Practice Address - Street 1:3949 EVANS AVE
Practice Address - Street 2:STE 102
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-9335
Practice Address - Country:US
Practice Address - Phone:239-939-2622
Practice Address - Fax:239-939-0151
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLARNP3164682367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL304438600Medicaid
G2164OtherBC BS FL
FL591783920OtherTAX ID