Healthcare Provider Details

I. General information

NPI: 1023995750
Provider Name (Legal Business Name): MRS. TERI ASHLEA SHOOP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2025
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 TOWNE CENTER BLVD BLDG 1200
POOLER GA
31322-4129
US

IV. Provider business mailing address

1000 TOWNE CENTER BLVD
POOLER GA
31322-4052
US

V. Phone/Fax

Practice location:
  • Phone: 912-748-2280
  • Fax:
Mailing address:
  • Phone: 912-748-2280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP287857
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: