Provider Demographics
NPI:1295862126
Name:HARVATIN, TERESA MARIE (DNP, ACNP-BC)
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:MARIE
Last Name:HARVATIN
Suffix:
Gender:F
Credentials:DNP, ACNP-BC
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:MARIE
Other - Last Name:LOTTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11234 ANDERSON ST # 1617
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-2804
Mailing Address - Country:US
Mailing Address - Phone:909-558-4200
Mailing Address - Fax:909-558-4212
Practice Address - Street 1:11234 ANDERSON ST # 1617
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-2804
Practice Address - Country:US
Practice Address - Phone:909-558-4200
Practice Address - Fax:909-558-4200
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO103285363L00000X
TX2101363LA2100X
TX832818363LA2100X
CA95007639363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07826512Medicaid
LA2136771Medicaid
LA2136771Medicaid