Provider Demographics
NPI:1306147905
Name:HALE, TERI LYNN (PA-C)
Entity type:Individual
Prefix:
First Name:TERI
Middle Name:LYNN
Last Name:HALE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TERI
Other - Middle Name:LYNN
Other - Last Name:FITZGERALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:600 S DOBSON RD
Mailing Address - Street 2:C.26
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-5678
Mailing Address - Country:US
Mailing Address - Phone:480-814-1560
Mailing Address - Fax:
Practice Address - Street 1:600 S DOBSON RD
Practice Address - Street 2:C.26
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5678
Practice Address - Country:US
Practice Address - Phone:480-814-1560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-12
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4707363AM0700X, 363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical