Provider Demographics
NPI:1275542946
Name:HARTZ, TERESA MARIE (APRN)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:MARIE
Last Name:HARTZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 E LAKE MEAD BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030-7187
Mailing Address - Country:US
Mailing Address - Phone:702-657-1503
Mailing Address - Fax:702-657-1583
Practice Address - Street 1:1815 E LAKE MEAD BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-7187
Practice Address - Country:US
Practice Address - Phone:702-657-1503
Practice Address - Fax:702-657-1583
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN001190363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM366019ZMABOtherMEDICARE PTAN
NVDK452YMedicare PIN
AZ031307Medicare UPIN
NMS45216Medicare UPIN
NMQ7732Medicaid