1639258072 NPI number — MRS. TONYA M TERWILLIGER PA-C

Table of content: MRS. TONYA M TERWILLIGER PA-C (NPI 1639258072)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639258072 NPI number — MRS. TONYA M TERWILLIGER PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TERWILLIGER
Provider First Name:
TONYA
Provider Middle Name:
M
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
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:
1639258072
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/18/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1450 6TH ST SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINTER HAVEN
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33880-4505
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
863-293-2147
Provider Business Mailing Address Fax Number:
863-294-2767

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26540 ACE AVE
Provider Second Line Business Practice Location Address:
SUITE 107, UNIT D
Provider Business Practice Location Address City Name:
LEESBURG
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34748-8279
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-530-2306
Provider Business Practice Location Address Fax Number:
352-533-4391
Provider Enumeration Date:
11/05/2006

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: 363A00000X , with the licence number:  PA9104043 , 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)

  • Identifier: P01198596 . This is a "RR MEDICARE ID#" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 0038Z . This is a "BCBS GROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com