Individual
TEQUILA ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1612 AIRPORT BLVD, WEST COLUMBIA, SC 29169-5016
(803) 380-6399
(877) 484-7187
Mailing address
1612 AIRPORT BLVD, WEST COLUMBIA, SC 29169-5016
(803) 380-6399
(877) 484-7187
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
29092
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NN0622
—
SC
Enumeration date
07/24/2024
Last updated
03/26/2026
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