Provider Demographics
NPI:1356647390
Name:MCGUIRE, THERESA M (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:M
Last Name:MCGUIRE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 ALEASE DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37334-7407
Mailing Address - Country:US
Mailing Address - Phone:931-625-5291
Mailing Address - Fax:
Practice Address - Street 1:62 ALEASE DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37334-7407
Practice Address - Country:US
Practice Address - Phone:931-625-5291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-09
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN15571363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily