Provider Demographics
NPI:1275601361
Name:MILLER, TERESA J (APN, CNS)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:J
Last Name:MILLER
Suffix:
Gender:F
Credentials:APN, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 THE TRAILS PKWY
Mailing Address - Street 2:
Mailing Address - City:HORSESHOE BAY
Mailing Address - State:TX
Mailing Address - Zip Code:78657-7107
Mailing Address - Country:US
Mailing Address - Phone:512-787-1736
Mailing Address - Fax:505-393-6051
Practice Address - Street 1:825 THE TRAILS PKWY
Practice Address - Street 2:
Practice Address - City:HORSESHOE BAY
Practice Address - State:TX
Practice Address - Zip Code:78657-7107
Practice Address - Country:US
Practice Address - Phone:512-787-1736
Practice Address - Fax:505-393-6051
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX683001364S00000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX156421303Medicaid
TX610563Medicare UPIN