Provider Demographics
NPI:1407423676
Name:FACH, TESSA DANIEL (NP)
Entity Type:Individual
Prefix:
First Name:TESSA
Middle Name:DANIEL
Last Name:FACH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 STRIPED LN
Mailing Address - Street 2:
Mailing Address - City:JOHNS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29455-9018
Mailing Address - Country:US
Mailing Address - Phone:912-237-1688
Mailing Address - Fax:
Practice Address - Street 1:102 W 8TH NORTH ST STE B
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-6656
Practice Address - Country:US
Practice Address - Phone:912-237-1688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24885363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily