Provider Demographics
NPI:1083663140
Name:CROSBY, TERESA COLLIER (FNP-BC)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:COLLIER
Last Name:CROSBY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8748
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-8748
Mailing Address - Country:US
Mailing Address - Phone:817-573-0444
Mailing Address - Fax:817-573-2733
Practice Address - Street 1:1021 HOLDEN ST
Practice Address - Street 2:
Practice Address - City:GLEN ROSE
Practice Address - State:TX
Practice Address - Zip Code:76043-4937
Practice Address - Country:US
Practice Address - Phone:817-573-0444
Practice Address - Fax:817-573-2733
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX536588363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG9755Medicaid
TXP40922Medicare UPIN