Provider Demographics
NPI:1245007483
Name:KOCH, TESSA KAY MARIE PARKER (FNP-BC)
Entity type:Individual
Prefix:
First Name:TESSA KAY
Middle Name:MARIE PARKER
Last Name:KOCH
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:TESSA KAY
Other - Middle Name:MARIE
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3001 METRO DR STE 460
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-1548
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:651-999-6970
Practice Address - Street 1:7500 FRANCE AVE S
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-3400
Practice Address - Country:US
Practice Address - Phone:952-927-6501
Practice Address - Fax:833-905-0988
Is Sole Proprietor?:No
Enumeration Date:2023-12-07
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10925363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily