Provider Demographics
NPI:1356328660
Name:BROGAN, TERRI-ANN K (DO)
Entity Type:Individual
Prefix:
First Name:TERRI-ANN
Middle Name:K
Last Name:BROGAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1395 N COURTENAY PKWY
Mailing Address - Street 2:SUITE 107
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-4400
Mailing Address - Country:US
Mailing Address - Phone:321-453-1955
Mailing Address - Fax:321-454-2406
Practice Address - Street 1:1395 N COURTENAY PKWY
Practice Address - Street 2:SUITE 107
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-4400
Practice Address - Country:US
Practice Address - Phone:321-453-1955
Practice Address - Fax:321-454-2406
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7484207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE4155Medicare ID - Type Unspecified
H27169Medicare UPIN