Provider Demographics
NPI:1083727713
Name:TEETER GUARINO, MARY LYNN (APRN)
Entity Type:Individual
Prefix:
First Name:MARY LYNN
Middle Name:
Last Name:TEETER GUARINO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2834 11TH AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-5502
Mailing Address - Country:US
Mailing Address - Phone:727-276-6809
Mailing Address - Fax:
Practice Address - Street 1:2834 11TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-5502
Practice Address - Country:US
Practice Address - Phone:727-276-6809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2909122363LG0600X
FLARNP2909122363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL304264200Medicaid
P66499Medicare UPIN
FLE7981YMedicare UPIN