MEDICARE: TERRI R YINGLING LSA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246ZC0007X	Surgical Assistant	187816	TX
2	246ZC0007X	Surgical Assistant	SA00847	TX
3	246Z00000X	Other Specialist/Technologist		TX

General Provider Information

NPI Number	:	1003370404
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRI R YINGLING LSA

Provider Business Mailing Address
First Line	:	7575 DR PHILLIPS BLVD STE 155
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32819-7220
Country	:	US
Telephone Number	:	407-982-4876
Fax Number	:	407-650-2754

Provider Business Practice Location Address
First Line	:	5301 ALPHA RD # 33
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75240-4355
Country	:	US
Telephone Number	:	407-982-4876
Fax Number	:	407-650-2754

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2019
Last Update Date	:	12/05/2025

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