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General NPI Number Information
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NPI Number | 1407423676
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Entity Type | Individual
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Provider Name | TESSA DANIEL FACH NP
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Gender | Female
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Dates
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Enumeration Date | 06/07/2021
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Last Update Date | 06/07/2021
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Provider Practice Location Address
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Address Line | 102 W 8TH NORTH ST STE B
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City | SUMMERVILLE
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State | SC
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Zip | 29483-6656
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Country | US
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Telephone | 912-237-1688
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Fax |
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Provider Business Mailing Address
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Address Line | 1030 STRIPED LN
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City | JOHNS ISLAND
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State | SC
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Zip | 29455-9018
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Country | US
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Telephone | 912-237-1688
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 24885
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License Number State | SC
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