Provider Demographics
NPI:1922825611
Name:MCKNIGHT, THERESA DENISE (RN)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:DENISE
Last Name:MCKNIGHT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7458 UNIVERSAL BLVD UNIT 4128
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-9262
Mailing Address - Country:US
Mailing Address - Phone:504-618-6788
Mailing Address - Fax:
Practice Address - Street 1:100 CAUSEWAY ST STE 24A
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-1315
Practice Address - Country:US
Practice Address - Phone:504-618-6788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-24
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9372841163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse