Healthcare Provider Details

I. General information

NPI: 1811804784
Provider Name (Legal Business Name): TEZEL ODESSA GERSPACHER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13620 CRAYTON BLVD STE A
HAGERSTOWN MD
21742-2335
US

IV. Provider business mailing address

200 TURKEY RUN LN
KEARNEYSVILLE WV
25430-5815
US

V. Phone/Fax

Practice location:
  • Phone: 240-313-3100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF08260936
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: