Provider Demographics
NPI:1104834506
Name:TESDALL-SARTORI, TERI RENEE (ARNP)
Entity Type:Individual
Prefix:MS
First Name:TERI
Middle Name:RENEE
Last Name:TESDALL-SARTORI
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:TERI
Other - Middle Name:RENEE
Other - Last Name:TEDALL-SARTORI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:19333 HWY 59 NORTH
Mailing Address - Street 2:SUITE 145
Mailing Address - City:HUMBEL
Mailing Address - State:TX
Mailing Address - Zip Code:77338
Mailing Address - Country:US
Mailing Address - Phone:281-540-5437
Mailing Address - Fax:281-540-2630
Practice Address - Street 1:19333 HIGHWAY 59 N
Practice Address - Street 2:SUITE 145
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-4204
Practice Address - Country:US
Practice Address - Phone:281-540-5437
Practice Address - Fax:281-540-2630
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2063652363LP0200X
TX782617363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL304787300Medicaid
FLY041FZMedicare PIN
FL304787300Medicaid