Provider Demographics
NPI:1245584291
Name:AZIZ, TERESITA OCTAVO (APN)
Entity Type:Individual
Prefix:MS
First Name:TERESITA
Middle Name:OCTAVO
Last Name:AZIZ
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:TERESITA
Other - Middle Name:OCTAVO
Other - Last Name:AZIZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:12 STEGMAN PL
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-1414
Mailing Address - Country:US
Mailing Address - Phone:201-724-4349
Mailing Address - Fax:
Practice Address - Street 1:1110 SOUTH AVE STE 305
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-3414
Practice Address - Country:US
Practice Address - Phone:718-226-4645
Practice Address - Fax:718-226-4670
Is Sole Proprietor?:No
Enumeration Date:2012-10-30
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00390300363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health