Healthcare Provider Details

I. General information

NPI: 1912418658
Provider Name (Legal Business Name): TERRYAN DOUGLAS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2017
Last Update Date: 08/14/2023
Certification Date: 08/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 S CONGRESS AVE STE 102
ATLANTIS FL
33462-6636
US

IV. Provider business mailing address

5700 LAKE WORTH RD STE 204
GREENACRES FL
33463-3213
US

V. Phone/Fax

Practice location:
  • Phone: 561-967-5033
  • Fax: 561-967-8974
Mailing address:
  • Phone: 561-966-7717
  • Fax: 888-316-2198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP61452031
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9298531
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: