MEDICARE: TERESA E HIRST CPNP

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	363L00000X	Nurse Practitioner	AP112853	TX
2	363LP0200X	Pediatric Nurse Practitioner	AP112853	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578665030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA E HIRST CPNP

Provider Business Mailing Address
First Line	:	12770 BANDERA RD
Second Line	:	APT 111
City	:	HELOTES
State	:	TX
Zip	:	78023-4007
Country	:	US
Telephone Number	:	907-854-0562
Fax Number	:

Provider Business Practice Location Address
First Line	:	4118 POND HILL RD
Second Line	:	SUITE 200
City	:	SHAVANO PARK
State	:	TX
Zip	:	78231-1281
Country	:	US
Telephone Number	:	210-692-3439
Fax Number	:	210-493-3444

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

Provider Enumeration Date	:	09/03/2006
Last Update Date	:	05/09/2024

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