1184268609 NPI number — MS. TERRY LYNN LIVELY CPCP

Table of content: MS. TERRY LYNN LIVELY CPCP (NPI 1184268609)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184268609 NPI number — MS. TERRY LYNN LIVELY CPCP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIVELY
Provider First Name:
TERRY
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CPCP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184268609
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/17/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7575 DR PHILLIPS BLVD STE 155
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32819-7220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-982-4876
Provider Business Mailing Address Fax Number:
407-650-2754

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1478 FM 2673
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANYON LAKE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78133-4583
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-982-4876
Provider Business Practice Location Address Fax Number:
407-650-2754
Provider Enumeration Date:
10/29/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 246Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)