Provider Demographics
NPI:1295701845
Name:PLASSE GOOSEN, TERESA MARIE (NP)
Entity type:Individual
Prefix:MS
First Name:TERESA
Middle Name:MARIE
Last Name:PLASSE GOOSEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 BEACHVIEW DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-7225
Mailing Address - Country:US
Mailing Address - Phone:757-619-6560
Mailing Address - Fax:
Practice Address - Street 1:1540 BEACHVIEW DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-7225
Practice Address - Country:US
Practice Address - Phone:757-619-6560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-24
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024165686363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010036917Medicaid
VA010036917Medicaid
002916S33Medicare ID - Type Unspecified