Provider Demographics
NPI:1578665030
Name:HIRST, TERESA E (CPNP)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:E
Last Name:HIRST
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12770 BANDERA RD
Mailing Address - Street 2:APT 111
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-4007
Mailing Address - Country:US
Mailing Address - Phone:907-854-0562
Mailing Address - Fax:
Practice Address - Street 1:4118 POND HILL RD
Practice Address - Street 2:SUITE 200
Practice Address - City:SHAVANO PARK
Practice Address - State:TX
Practice Address - Zip Code:78231-1281
Practice Address - Country:US
Practice Address - Phone:210-692-3439
Practice Address - Fax:210-493-3444
Is Sole Proprietor?:No
Enumeration Date:2006-09-03
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXAP112853363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKNP1800Medicaid