MEDICARE: TEAISHA DALIS FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	173168	AL
2	363LF0000X	Family Nurse Practitioner	F12220793	AL
3	363LF0000X	Family Nurse Practitioner	2022045151	AL

General Provider Information

NPI Number	:	1326746306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TEAISHA DALIS FNP

Provider Business Mailing Address
First Line	:	2 CHASE CORPORATE DR
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35244-1016
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 CHASE CORPORATE DR
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35244-1016
Country	:	US
Telephone Number	:	860-902-6287
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2023
Last Update Date	:	02/20/2023

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