Individual
TEA HASANOVIC
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2101 N WHITLEY DR, FRUITLAND, ID 83619-2132
(208) 452-5999
Mailing address
2101 N WHITLEY DR, FRUITLAND, ID 83619-2132
(208) 452-5999
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-1978
ID
Other
Enumeration date
12/08/2020
Last updated
04/17/2023
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