Healthcare Provider Details

I. General information

NPI: 1134936594
Provider Name (Legal Business Name): GREG TERRYN RN-BSN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2024
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4315 PABLO OAKS CT
JACKSONVILLE FL
32224-9667
US

IV. Provider business mailing address

12669 JOSSLYN LN
JACKSONVILLE FL
32246-2269
US

V. Phone/Fax

Practice location:
  • Phone: 904-953-7286
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number9410529
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: