MEDICARE: TEANN PHILIPPIS PA-C

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
1	363AM0700X	Medical Physician Assistant	2759	AZ

General Provider Information

NPI Number	:	1922159557
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TEANN PHILIPPIS PA-C

Provider Business Mailing Address
First Line	:	3330 E ROCKWOOD DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85050-3263
Country	:	US
Telephone Number	:	602-942-3750
Fax Number	:	602-942-4245

Provider Business Practice Location Address
First Line	:	3229 E GREENWAY RD
Second Line	:	SUITE 101
City	:	PHOENIX
State	:	AZ
Zip	:	85032-4508
Country	:	US
Telephone Number	:	602-942-3750
Fax Number	:	602-942-4245

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2007
Last Update Date	:	03/07/2023

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