Provider Demographics
NPI:1033487426
Name:PREMIER ENDOCRINOLOGY PLLC
Entity Type:Organization
Organization Name:PREMIER ENDOCRINOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:ADADZEWA
Authorized Official - Last Name:FYNN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-593-2910
Mailing Address - Street 1:3004 17TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-6011
Mailing Address - Country:US
Mailing Address - Phone:407-593-2910
Mailing Address - Fax:407-593-2913
Practice Address - Street 1:3004 17TH ST
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-6011
Practice Address - Country:US
Practice Address - Phone:407-593-2910
Practice Address - Fax:407-593-2913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-13
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME109189207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
12316257OtherCAQH