Provider Demographics
NPI:1326442492
Name:TELLIS, CHRISTINE H (FNP-C)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:H
Last Name:TELLIS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:H
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:57675 29 PALMS HWY
Mailing Address - Street 2:SUITE 111
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-3098
Mailing Address - Country:US
Mailing Address - Phone:760-365-8500
Mailing Address - Fax:760-365-8599
Practice Address - Street 1:66675 PIERSON BLVD
Practice Address - Street 2:
Practice Address - City:DESERT HOT SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92240-3737
Practice Address - Country:US
Practice Address - Phone:760-676-5240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-17
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95000048363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily