Provider Demographics
NPI:1124017736
Name:FROCK, TERRI LYN (EDD MSN ARNP-BC)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:LYN
Last Name:FROCK
Suffix:
Gender:F
Credentials:EDD MSN ARNP-BC
Other - Prefix:
Other - First Name:TERRY
Other - Middle Name:LYN
Other - Last Name:FROCK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:EDD MSN ARNP-BC
Mailing Address - Street 1:2210 NE 40TH CT
Mailing Address - Street 2:
Mailing Address - City:LIGHTHOUSE POINT
Mailing Address - State:FL
Mailing Address - Zip Code:33064-7328
Mailing Address - Country:US
Mailing Address - Phone:954-941-8151
Mailing Address - Fax:
Practice Address - Street 1:550 SW 3RD ST
Practice Address - Street 2:SUITE 305
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-6934
Practice Address - Country:US
Practice Address - Phone:954-941-3333
Practice Address - Fax:954-941-2054
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP832332363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner