Provider Demographics
NPI:1821173840
Name:PISANI, TERESA LYNN (PA C)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:LYNN
Last Name:PISANI
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:854 W JAMES CAMPBELL BLVD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-4659
Mailing Address - Country:US
Mailing Address - Phone:931-540-4255
Mailing Address - Fax:931-490-4654
Practice Address - Street 1:5421 MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174-4410
Practice Address - Country:US
Practice Address - Phone:931-486-2500
Practice Address - Fax:931-486-3748
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA0000000531363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN36887471Medicaid
TN3710089Medicaid
TN4168268OtherBCBST
TNCE0561Medicare PIN
S88994Medicare UPIN
TN3710089Medicare PIN
TN36887471Medicaid