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General NPI Number Information
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NPI Number | 1336638337
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Entity Type | Individual
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Provider Name | TERRENCE PARK
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Gender | Male
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Dates
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Enumeration Date | 05/04/2018
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Last Update Date | 10/04/2023
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Provider Practice Location Address
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Address Line | 5401 S CONGRESS AVE STE 201
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City | ATLANTIS
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State | FL
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Zip | 33462-6637
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Country | US
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Telephone | 561-995-6971
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Fax |
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Provider Business Mailing Address
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Address Line | 5301 S CONGRESS AVE STE 201
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City | ATLANTIS
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State | FL
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Zip | 33462-1149
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Country | US
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Telephone | 551-666-8332
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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 | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | ME161166
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License Number State | FL
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