Provider Demographics
NPI:1063450864
Name:ROY, TERRY D (CRNA)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:D
Last Name:ROY
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 GULF BLVD
Mailing Address - Street 2:APT 15G
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33767-2879
Mailing Address - Country:US
Mailing Address - Phone:727-434-0891
Mailing Address - Fax:727-581-0357
Practice Address - Street 1:1340 GULF BLVD
Practice Address - Street 2:APT 15G
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33767-2879
Practice Address - Country:US
Practice Address - Phone:727-434-0891
Practice Address - Fax:727-823-9502
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP816782367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00467515OtherRAILROAD MEDICARE IDENTIFIER
FLP00467515OtherRAILROAD MEDICARE IDENTIFIER