Provider Demographics
NPI:1922159557
Name:PHILIPPIS, TEANN (PA-C)
Entity Type:Individual
Prefix:
First Name:TEANN
Middle Name:
Last Name:PHILIPPIS
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 1:3330 E ROCKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-3263
Mailing Address - Country:US
Mailing Address - Phone:602-942-3750
Mailing Address - Fax:602-942-4245
Practice Address - Street 1:3229 E GREENWAY RD
Practice Address - Street 2:SUITE 101
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-4508
Practice Address - Country:US
Practice Address - Phone:602-942-3750
Practice Address - Fax:602-942-4245
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2759363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZMP1286396OtherDEA