Healthcare Provider Details

I. General information

NPI: 1114797552
Provider Name (Legal Business Name): TERRI LYNN ROBERTS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2024
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

158 US HIGHWAY 98
EASTPOINT FL
32328-3692
US

IV. Provider business mailing address

2804 REMINGTON GREEN CIR STE 2
TALLAHASSEE FL
32308-1550
US

V. Phone/Fax

Practice location:
  • Phone: 850-670-8585
  • Fax: 850-670-8582
Mailing address:
  • Phone: 850-385-4494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11030474
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: