Healthcare Provider Details

I. General information

NPI: 1053345264
Provider Name (Legal Business Name): TERRIE LYNN FRANKENFIELD R
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 E 23RD ST
PANAMA CITY FL
32405-5307
US

IV. Provider business mailing address

2309 MINNESOTA AVE
LYNN HAVEN FL
32444-4810
US

V. Phone/Fax

Practice location:
  • Phone: 850-747-8822
  • Fax: 850-747-8664
Mailing address:
  • Phone: 850-271-6195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number48898
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: