MEDICARE: TERRI LYN FROCK EDD MSN ARNP-BC

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	363L00000X	Nurse Practitioner	ARNP832332	FL

General Provider Information

NPI Number	:	1124017736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRI LYN FROCK EDD MSN ARNP-BC

Provider Business Mailing Address
First Line	:	2210 NE 40TH CT
Second Line	:
City	:	LIGHTHOUSE POINT
State	:	FL
Zip	:	33064-7328
Country	:	US
Telephone Number	:	954-941-8151
Fax Number	:

Provider Business Practice Location Address
First Line	:	550 SW 3RD ST
Second Line	:	SUITE 305
City	:	POMPANO BEACH
State	:	FL
Zip	:	33060-6934
Country	:	US
Telephone Number	:	954-941-3333
Fax Number	:	954-941-2054

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

Provider Enumeration Date	:	10/17/2005
Last Update Date	:	07/08/2007

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