Provider Demographics
NPI:1477519064
Name:SCAVONE, TERESA M (PNP)
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:M
Last Name:SCAVONE
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:MS
Other - First Name:TERESA
Other - Middle Name:M
Other - Last Name:THIBADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PNP
Mailing Address - Street 1:PO BOX 8500
Mailing Address - Street 2:LOCKBOX 7642
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-7642
Mailing Address - Country:US
Mailing Address - Phone:813-281-8115
Mailing Address - Fax:916-453-2373
Practice Address - Street 1:2425 STOCKTON BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2215
Practice Address - Country:US
Practice Address - Phone:916-453-2049
Practice Address - Fax:916-453-2373
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA506949363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics