Provider Demographics
NPI:1306185954
Name:PACHECO, TERRI LYN (FNP-C)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:LYN
Last Name:PACHECO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-2135 FORT WEAVER RD
Mailing Address - Street 2:SUITE 170
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-1940
Mailing Address - Country:US
Mailing Address - Phone:808-676-5331
Mailing Address - Fax:808-671-2931
Practice Address - Street 1:91-2135 FT. WEAVER ROAD
Practice Address - Street 2:SUITE 150
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-1929
Practice Address - Country:US
Practice Address - Phone:808-676-5331
Practice Address - Fax:808-671-2931
Is Sole Proprietor?:No
Enumeration Date:2013-02-01
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1534363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily