Provider Demographics
NPI:1801135108
Name:PATIN, TERESA JUNE
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:JUNE
Last Name:PATIN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 S DOBSON RD STE 316
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-4710
Mailing Address - Country:US
Mailing Address - Phone:480-545-0059
Mailing Address - Fax:480-632-2134
Practice Address - Street 1:1520 S DOBSON RD STE 316
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-4710
Practice Address - Country:US
Practice Address - Phone:480-545-0059
Practice Address - Fax:480-632-2134
Is Sole Proprietor?:No
Enumeration Date:2013-02-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP7512363LW0102X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health