Provider Demographics
NPI:1720319940
Name:TERESCHUK, ANASTASIA MIKEL (ACNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:ANASTASIA
Middle Name:MIKEL
Last Name:TERESCHUK
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:MRS
Other - First Name:ANASTASIA
Other - Middle Name:MIKEL
Other - Last Name:TERESCHUK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSN RN ACNP-BC
Mailing Address - Street 1:281 UNDERPASS DR
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:TN
Mailing Address - Zip Code:37841-5885
Mailing Address - Country:US
Mailing Address - Phone:423-569-5454
Mailing Address - Fax:423-569-5932
Practice Address - Street 1:281 UNDERPASS DR
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:TN
Practice Address - Zip Code:37841-5885
Practice Address - Country:US
Practice Address - Phone:423-569-5454
Practice Address - Fax:423-569-5932
Is Sole Proprietor?:No
Enumeration Date:2010-01-28
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN157417163W00000X
TN14696363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1031505037OtherMEDICARE
TN1518627Medicaid
TN103I509091Medicare PIN