Provider Demographics
NPI:1245575612
Name:NEVINS, TERESA ROYER (PAC)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:ROYER
Last Name:NEVINS
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:MARIE
Other - Last Name:ROYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:4881 NW 8TH AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4582
Mailing Address - Country:US
Mailing Address - Phone:352-373-4321
Mailing Address - Fax:352-373-0555
Practice Address - Street 1:4343 W NEWBERRY RD
Practice Address - Street 2:SUITE 14
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-2817
Practice Address - Country:US
Practice Address - Phone:352-373-4321
Practice Address - Fax:352-373-0555
Is Sole Proprietor?:No
Enumeration Date:2012-12-11
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9108712363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015003800Medicaid
FLIE497ZMedicare PIN