Provider Demographics
NPI:1639998024
Name:SCOTT, TERESINIA LANAE (APN)
Entity type:Individual
Prefix:
First Name:TERESINIA
Middle Name:LANAE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:TERERSINIA
Other - Middle Name:LANAE
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APN
Mailing Address - Street 1:5094 SADDLE CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:ELLENWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30294-4363
Mailing Address - Country:US
Mailing Address - Phone:678-365-1512
Mailing Address - Fax:
Practice Address - Street 1:5094 SADDLE CREEK CIR
Practice Address - Street 2:
Practice Address - City:ELLENWOOD
Practice Address - State:GA
Practice Address - Zip Code:30294-4363
Practice Address - Country:US
Practice Address - Phone:678-365-1512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-03
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN134228363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily