MEDICARE: MS. TERESE MARY WARNER CRNA

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	367500000X	Certified Registered Nurse Anesthetist	543487	TX
2	367500000X	Certified Registered Nurse Anesthetist	9262060	FL
3	367500000X	Certified Registered Nurse Anesthetist	123895	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700862844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TERESE MARY WARNER CRNA

Provider Business Mailing Address
First Line	:	1590 CENTURY ACRES LANE
Second Line	:
City	:	SAINT JOHNS
State	:	FL
Zip	:	32259
Country	:	US
Telephone Number	:	904-710-6811
Fax Number	:

Provider Business Practice Location Address
First Line	:	1590 CENTURY ACRES LANE
Second Line	:
City	:	SAINT JOHNS
State	:	FL
Zip	:	32259
Country	:	US
Telephone Number	:	904-710-6811
Fax Number	:

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

Provider Enumeration Date	:	12/20/2005
Last Update Date	:	11/18/2013

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