Provider Demographics
NPI:1962620674
Name:TESKY, JAMIE NICHOLE (CNP)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:NICHOLE
Last Name:TESKY
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:NICHOLE
Other - Last Name:BORNITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7597 N SWEET RIVER DR
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-7772
Mailing Address - Country:US
Mailing Address - Phone:208-818-4404
Mailing Address - Fax:
Practice Address - Street 1:2199 N MERRITT CREEK LOOP
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814
Practice Address - Country:US
Practice Address - Phone:208-665-7546
Practice Address - Fax:208-667-4607
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID61038363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner