Healthcare Provider Details

I. General information

NPI: 1033754296
Provider Name (Legal Business Name): TERRY DURAN APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2019
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9116 GRAVELLY LAKE DR SW
TACOMA WA
98499-3148
US

IV. Provider business mailing address

11714 SILVER SKY
SAN ANTONIO TX
78254-4650
US

V. Phone/Fax

Practice location:
  • Phone: 253-461-1962
  • Fax: 833-962-6176
Mailing address:
  • Phone: 253-461-1962
  • Fax: 833-962-6176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61376797
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP61376797
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: