Provider Demographics
NPI:1568835890
Name:GAITHER, TERESA MARIE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:MARIE
Last Name:GAITHER
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 1:3083 S COTTONWOOD CT
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-2384
Mailing Address - Country:US
Mailing Address - Phone:480-712-8319
Mailing Address - Fax:480-712-1305
Practice Address - Street 1:16515 S. 40TH ST, BLDG 9, SUITE 143
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-0560
Practice Address - Country:US
Practice Address - Phone:480-712-8319
Practice Address - Fax:480-712-1305
Is Sole Proprietor?:No
Enumeration Date:2015-11-09
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP8166363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAP61336652OtherLICENSE
FLAPRN11020482OtherLICENSE
AZ080049Medicaid
ID68527OtherLICENSE
COAPN0002960OtherLICENSE
NVAPRN-CNP934913OtherLICENSE
F0915793OtherBOARD
TX1023833OtherLICENSE
AZAP8166OtherLICENSE