Provider Demographics
NPI:1902582935
Name:VELASQUEZ, TERESA MARIE (FNP)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:MARIE
Last Name:VELASQUEZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1226 E CHAMPLAIN DR APT 203
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-5066
Mailing Address - Country:US
Mailing Address - Phone:559-349-9089
Mailing Address - Fax:
Practice Address - Street 1:1340 W HERNDON AVE STE 101
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-7180
Practice Address - Country:US
Practice Address - Phone:559-438-6577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF01230599363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily