1124017736 NPI number — TERRI LYN FROCK EDD MSN ARNP-BC

Table of content: TERRI LYN FROCK EDD MSN ARNP-BC (NPI 1124017736)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124017736 NPI number — TERRI LYN FROCK EDD MSN ARNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FROCK
Provider First Name:
TERRI
Provider Middle Name:
LYN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
EDD MSN ARNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FROCK
Provider Other First Name:
TERRY
Provider Other Middle Name:
LYN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
EDD MSN ARNP-BC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1124017736
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2210 NE 40TH CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LIGHTHOUSE POINT
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33064-7328
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-941-8151
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
550 SW 3RD ST
Provider Second Line Business Practice Location Address:
SUITE 305
Provider Business Practice Location Address City Name:
POMPANO BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33060-6934
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-941-3333
Provider Business Practice Location Address Fax Number:
954-941-2054
Provider Enumeration Date:
10/17/2005

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: 363L00000X , with the licence number:  ARNP832332 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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