Provider Demographics
NPI:1043588528
Name:NANNA, TERIANNE
Entity Type:Individual
Prefix:
First Name:TERIANNE
Middle Name:
Last Name:NANNA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9320 NW 39TH COURT
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FLORIDA
Mailing Address - Zip Code:33351
Mailing Address - Country:UM
Mailing Address - Phone:954-749-3727
Mailing Address - Fax:
Practice Address - Street 1:9320 NW 39TH CT
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-5935
Practice Address - Country:US
Practice Address - Phone:954-749-3727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-12
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLN500814867510235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSZ5714OtherPROVISIONAL SPEECH-LANGUAGE PATHOLOGIST