Provider Demographics
NPI:1457002644
Name:GERAGHTY, TESHA (FNP)
Entity Type:Individual
Prefix:
First Name:TESHA
Middle Name:
Last Name:GERAGHTY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 FRANKLIN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-3564
Mailing Address - Country:US
Mailing Address - Phone:219-872-6200
Mailing Address - Fax:219-879-2915
Practice Address - Street 1:200 ALFRED ST
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360
Practice Address - Country:US
Practice Address - Phone:219-872-6200
Practice Address - Fax:219-879-2915
Is Sole Proprietor?:No
Enumeration Date:2022-01-10
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71012089A363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care