MEDICARE: TERESA LE FNP-C

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	363LF0000X	Family Nurse Practitioner	270647	AZ
2	363L00000X	Nurse Practitioner	AP70002844	WA

General Provider Information

NPI Number	:	1780475244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA LE FNP-C

Provider Business Mailing Address
First Line	:	5350 N 16TH ST STE 102
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-3213
Country	:	US
Telephone Number	:	602-699-4208
Fax Number	:	602-699-4209

Provider Business Practice Location Address
First Line	:	5350 N 16TH ST STE 102
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-3213
Country	:	US
Telephone Number	:	602-699-4208
Fax Number	:	602-699-4209

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

Provider Enumeration Date	:	05/14/2025
Last Update Date	:	01/27/2026

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Directions to “ TERESA LE FNP-C” Practice Location

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