Provider Demographics
NPI:1750801791
Name:TEZZA, SYBIL (FNP)
Entity type:Individual
Prefix:
First Name:SYBIL
Middle Name:
Last Name:TEZZA
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 1:105 FAULKNER CIR
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29651-2200
Mailing Address - Country:US
Mailing Address - Phone:864-706-6409
Mailing Address - Fax:
Practice Address - Street 1:1 HAVENWOOD LN
Practice Address - Street 2:
Practice Address - City:TRAVELERS REST
Practice Address - State:SC
Practice Address - Zip Code:29690-9447
Practice Address - Country:US
Practice Address - Phone:864-834-8013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-21
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21084363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSCC5036067OtherMEDICARE PIN
SCSCC5036084OtherMEDICARE PIN
SCSCC503J577OtherMEDICARE PIN
SCNP5526Medicaid