MEDICARE: MS. TERESA MICHELLE POOLE ARNP

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	363LP0200X	Pediatric Nurse Practitioner	ARNP9162930	FL

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	:	1942435706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TERESA MICHELLE POOLE ARNP

Provider Business Mailing Address
First Line	:	7904 SCHOOLHOUSE AVE NW
Second Line	:
City	:	GIG HARBOR
State	:	WA
Zip	:	98335-8359
Country	:	US
Telephone Number	:	813-629-2017
Fax Number	:

Provider Business Practice Location Address
First Line	:	9040A JACKSON AVE MADIGAN ARMY MEDICAL CENTER JBLM
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98431-6307
Country	:	US
Telephone Number	:	253-968-3066
Fax Number	:

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

Provider Enumeration Date	:	05/22/2009
Last Update Date	:	05/05/2019

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