Provider Demographics
NPI:1023995750
Name:SHOOP, TERI ASHLEA
Entity type:Individual
Prefix:MRS
First Name:TERI
Middle Name:ASHLEA
Last Name:SHOOP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 661
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:GA
Mailing Address - Zip Code:31321-0661
Mailing Address - Country:US
Mailing Address - Phone:912-547-9482
Mailing Address - Fax:
Practice Address - Street 1:1000 TOWNE CENTER BLVD BLDG 1200
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-4129
Practice Address - Country:US
Practice Address - Phone:912-748-2280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-15
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN287857363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily