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NPI Code Detail

MEDICARE: TERESA A GANNON NURSE PRACTITIONER

MEDICARE: TERESA A GANNON NURSE PRACTITIONER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner285061AZ

General Provider Information

NPI Number : 1821392424
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERESA A GANNON NURSE PRACTITIONER
Provider Business Mailing Address
First Line : 28138 N TATUM BLVD, CAVE CREEK, AZ 85331
Second Line :
City : CAVE CREEK
State : AZ
Zip : 85331
Country : US
Telephone Number : 518-878-7491
Fax Number :
Provider Business Practice Location Address
First Line : 28138 N TATUM BLVD
Second Line :
City : CAVE CREEK
State : AZ
Zip : 85331-6303
Country : US
Telephone Number : 866-389-2727
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/23/2010
Last Update Date : 12/04/2025

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Directions to “ TERESA A GANNON NURSE PRACTITIONER” Practice Location

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