Provider Demographics
NPI:1114916301
Name:BECK, TERRI (PA-C)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:
Last Name:BECK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17222 HOSPITAL BLVD STE 346
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34601-8925
Mailing Address - Country:US
Mailing Address - Phone:352-796-3334
Mailing Address - Fax:352-796-3323
Practice Address - Street 1:17222 HOSPITAL BLVD STE 346
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34601-8925
Practice Address - Country:US
Practice Address - Phone:352-796-3334
Practice Address - Fax:352-796-3323
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102849207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
851087Medicare UPIN
FL43459YMedicare ID - Type Unspecified