Healthcare Provider Details

I. General information

NPI: 1568758597
Provider Name (Legal Business Name): TERI LYNN CHAVIRA NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2011
Last Update Date: 06/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 CONCORD TER
SUNRISE FL
33323-2843
US

IV. Provider business mailing address

2807 NORFOLK DR
AUSTIN TX
78745-6842
US

V. Phone/Fax

Practice location:
  • Phone: 800-243-3839
  • Fax: 954-851-1838
Mailing address:
  • Phone: 512-560-6244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number548189
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: