Provider Demographics
NPI:1336614858
Name:LOERA, TERESA (FNP-C)
Entity type:Individual
Prefix:MS
First Name:TERESA
Middle Name:
Last Name:LOERA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 W PEORIA AVE
Mailing Address - Street 2:A105
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-4069
Mailing Address - Country:US
Mailing Address - Phone:602-918-3225
Mailing Address - Fax:833-992-2059
Practice Address - Street 1:3201 W PEORIA AVE
Practice Address - Street 2:A105
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-4609
Practice Address - Country:US
Practice Address - Phone:602-918-3225
Practice Address - Fax:833-992-2059
Is Sole Proprietor?:No
Enumeration Date:2018-10-11
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN157495163W00000X
AZAP11478363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ545062Medicaid
AZAP11478OtherCERTIFIED NURSE PRACTITIONER
F06182018OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS