Healthcare Provider Details

I. General information

NPI: 1336851617
Provider Name (Legal Business Name): TERRISHA FLOYD APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2022
Last Update Date: 12/19/2022
Certification Date: 12/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W MORENO ST
PENSACOLA FL
32501-2316
US

IV. Provider business mailing address

1504 DOUGLAS AVE
BREWTON AL
36426-1114
US

V. Phone/Fax

Practice location:
  • Phone: 850-434-4011
  • Fax:
Mailing address:
  • Phone: 205-441-5707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11022981
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: