Provider Demographics
NPI:1033115399
Name:BARR, TERESE (NP)
Entity Type:Individual
Prefix:
First Name:TERESE
Middle Name:
Last Name:BARR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 SW SAINT LUCIE WEST BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-2109
Mailing Address - Country:US
Mailing Address - Phone:772-878-7078
Mailing Address - Fax:866-389-2727
Practice Address - Street 1:1300 SW SAINT LUCIE WEST BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-2109
Practice Address - Country:US
Practice Address - Phone:772-878-7078
Practice Address - Fax:866-389-2727
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF331150363LF0000X
FLARNP9390518363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDD1802Medicare PIN
P46022Medicare UPIN
NYP00011537Medicare PIN
NYJ400001969Medicare PIN