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General NPI Number Information
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NPI Number | 1780537670
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Entity Type | Individual
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Provider Name | TERRY FORMAN CTRI, ESMHL
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Gender | Female
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Dates
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Enumeration Date | 02/19/2026
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Last Update Date | 02/19/2026
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Provider Practice Location Address
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Address Line | 11820 DENTON AVE
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City | HUDSON
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State | FL
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Zip | 34667-5419
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Country | US
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Telephone | 727-862-9101
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Fax | 888-345-5315
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Provider Business Mailing Address
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Address Line | 13803 MICHELLE AVE
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City | HUDSON
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State | FL
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Zip | 34667-1542
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Country | US
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Telephone | 303-478-5708
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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 | 171W00000X
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Taxonomy Name | Contractor
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License Number | 6997980
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License Number State | FL
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