Provider Demographics
NPI:1568758597
Name:CHAVIRA, TERI LYNN (NNP)
Entity Type:Individual
Prefix:MS
First Name:TERI
Middle Name:LYNN
Last Name:CHAVIRA
Suffix:
Gender:F
Credentials:NNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2807 NORFOLK DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-6842
Mailing Address - Country:US
Mailing Address - Phone:512-560-6244
Mailing Address - Fax:
Practice Address - Street 1:1301 CONCORD TER
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323-2843
Practice Address - Country:US
Practice Address - Phone:800-243-3839
Practice Address - Fax:954-851-1838
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-28
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX548189363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal