Healthcare Provider Details

I. General information

NPI: 1558870329
Provider Name (Legal Business Name): TERESA ANN SCANLAN NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TERESA ANN STEVERMER

II. Dates (important events)

Enumeration Date: 09/25/2017
Last Update Date: 01/16/2023
Certification Date: 01/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 10TH ST N STE 2A
ST PETERSBURG FL
33705-1407
US

IV. Provider business mailing address

620 10TH ST N STE 2A
ST PETERSBURG FL
33705-1407
US

V. Phone/Fax

Practice location:
  • Phone: 727-824-8243
  • Fax:
Mailing address:
  • Phone: 727-824-8243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5428
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11017893
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: