Healthcare Provider Details

I. General information

NPI: 1942555123
Provider Name (Legal Business Name): CARMENETTA ALICIA TERRELL BS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LISA TERRELL BS

II. Dates (important events)

Enumeration Date: 07/13/2012
Last Update Date: 07/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3238 S LECANTO HWY
LECANTO FL
34461-9025
US

IV. Provider business mailing address

5664 SW 60TH AVE
OCALA FL
34474-5677
US

V. Phone/Fax

Practice location:
  • Phone: 352-628-5020
  • Fax: 352-628-2016
Mailing address:
  • Phone: 352-291-5555
  • Fax: 352-291-9536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: