Provider Demographics
NPI:1942435706
Name:POOLE, TERESA MICHELLE (ARNP)
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:MICHELLE
Last Name:POOLE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7904 SCHOOLHOUSE AVE NW
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-8359
Mailing Address - Country:US
Mailing Address - Phone:813-629-2017
Mailing Address - Fax:
Practice Address - Street 1:9040A JACKSON AVE MADIGAN ARMY MEDICAL CENTER JBLM
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-6307
Practice Address - Country:US
Practice Address - Phone:253-968-3066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-22
Last Update Date:2019-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9162930363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013828700Medicaid