Healthcare Provider Details

I. General information

NPI: 1871001008
Provider Name (Legal Business Name): TEARA DILKS NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2018
Last Update Date: 07/13/2023
Certification Date: 07/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 E CHEVES ST
FLORENCE SC
29506-2617
US

IV. Provider business mailing address

2924 CID RD
LEXINGTON NC
27292-6154
US

V. Phone/Fax

Practice location:
  • Phone: 843-777-2000
  • Fax:
Mailing address:
  • Phone: 336-469-2856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number21798
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License NumberDRAU-DOFHEN
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: