Provider Demographics
NPI:1144583238
Name:TATUM, TERESE (FNP)
Entity Type:Individual
Prefix:
First Name:TERESE
Middle Name:
Last Name:TATUM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 BON AIR CTR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904-3000
Mailing Address - Country:US
Mailing Address - Phone:415-578-3095
Mailing Address - Fax:415-291-0489
Practice Address - Street 1:350 BON AIR CTR
Practice Address - Street 2:SUITE 200
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-3000
Practice Address - Country:US
Practice Address - Phone:415-578-3095
Practice Address - Fax:415-291-0489
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-22
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20100363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily