Active NPI
Theresa Anne Raskauskas, MSN, FNP-BC, PMHNP-B
- Psychiatric/Mental Health Nurse Practitioner
- Phoenix, AZ
National Provider Identifier
1114294147
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner
- License
- AP10020
- Practice address
- 4212 N 16TH St
Phoenix, AZ 85016-5319 - Phone
- (602) 163-1200
- Fax
- (602) 263-1625
- NPI assigned
- Nov 18, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | RN206698 | AZ | |
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | AP10020 | AZ | Primary |
Addresses
Primary practice location
4212 N 16TH St
Phoenix, AZ 85016-5319
Mailing address
PO Box 31001-0698
Pasadena, CA 91110-0698
Phone (602) 263-1200
Other practice location 1
912 13th Ave
Belmar, NJ 07719-2805
Phone (732) 894-3383
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| AP10020 | Other | AZ | APN LICENSE |
| RN206698 | Other | AZ | RN LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Science - Nursing, Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN206698 | AZ | MD | Psychiatric/Mental Health Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1321574400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1556064000000",
"number": "1114294147",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 31001-0698",
"city": "PASADENA",
"state": "CA",
"postal_code": "911100698",
"telephone_number": "602-263-1200"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4212 N 16TH ST",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850165319",
"telephone_number": "602-163-1200",
"fax_number": "602-263-1625"
}
],
"practiceLocations": [
{
"address_1": "912 13th Ave",
"address_purpose": "LOCATION",
"city": "Belmar",
"state": "NJ",
"postal_code": "077192805",
"country_code": "US",
"telephone_number": "732-894-3383",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "RASKAUSKAS",
"first_name": "THERESA",
"middle_name": "ANNE",
"name_prefix": "Ms.",
"credential": "MSN, FNP-BC, PMHNP-B",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-11-18",
"last_updated": "2019-04-24",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0808X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Psychiatric/Mental Health",
"state": "AZ",
"license": "RN206698",
"primary": false
},
{
"code": "363LP0808X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Psychiatric/Mental Health",
"state": "AZ",
"license": "AP10020",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "APN LICENSE",
"identifier": "AP10020",
"state": "AZ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RN LICENSE",
"identifier": "RN206698",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.