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General NPI Number Information
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NPI Number | 1326542747
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Entity Type | Individual
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Provider Name | TERRIE JENNIFER DUFORT NP
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Gender | Female
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Dates
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Enumeration Date | 03/20/2018
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Last Update Date | 03/20/2018
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Provider Practice Location Address
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Address Line | 9690 W SAMPLE RD STE 101
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City | CORAL SPRINGS
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State | FL
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Zip | 33065-4031
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Country | US
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Telephone | 954-346-8800
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Fax |
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Provider Business Mailing Address
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Address Line | 11120 NW 19TH ST
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City | CORAL SPRINGS
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State | FL
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Zip | 33071-5701
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 9207644
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License Number State | FL
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