Provider Demographics
NPI:1093180630
Name:HOWARD, TERESA
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:HOWARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:ANN
Other - Last Name:HOWARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:16565 OLD POST RD
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31566-4619
Mailing Address - Country:US
Mailing Address - Phone:912-230-0051
Mailing Address - Fax:
Practice Address - Street 1:3400 PARKWOOD DR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4782
Practice Address - Country:US
Practice Address - Phone:912-466-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-08
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN093992363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily