Provider Demographics
NPI:1083165906
Name:PEREZ, TESHARA (AGACNP-BC)
Entity type:Individual
Prefix:
First Name:TESHARA
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4324 23RD ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1812
Mailing Address - Country:US
Mailing Address - Phone:806-701-4263
Mailing Address - Fax:806-701-4184
Practice Address - Street 1:4321 MARSHA SHARP FWY
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79407-2504
Practice Address - Country:US
Practice Address - Phone:806-686-3500
Practice Address - Fax:806-701-4973
Is Sole Proprietor?:No
Enumeration Date:2016-10-14
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP132271363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care