Healthcare Provider Details

I. General information

NPI: 1942435706
Provider Name (Legal Business Name): TERESA MICHELLE POOLE ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2009
Last Update Date: 05/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9040A JACKSON AVE MADIGAN ARMY MEDICAL CENTER JBLM
TACOMA WA
98431-6307
US

IV. Provider business mailing address

7904 SCHOOLHOUSE AVE NW
GIG HARBOR WA
98335-8359
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-3066
  • Fax:
Mailing address:
  • Phone: 813-629-2017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberARNP9162930
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: