Provider Demographics
NPI:1154321420
Name:MATZKE, TERESA MARIE (FNP)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:MARIE
Last Name:MATZKE
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 1:5400 FRANTZ RD 250
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-6102
Mailing Address - Country:US
Mailing Address - Phone:614-544-6161
Mailing Address - Fax:614-544-6370
Practice Address - Street 1:561 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-1410
Practice Address - Country:US
Practice Address - Phone:740-615-1000
Practice Address - Fax:740-615-2565
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCNP.14059363LF0000X
OH14059363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0082732Medicaid
OHH185562OtherMEDICARE
NC2592223CMedicare PIN
NC2592223BMedicare PIN
NCQ28040Medicare UPIN