Provider Demographics
NPI:1376974899
Name:DOUGLAS, TERRY ANN (AGNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:TERRY
Middle Name:ANN
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:AGNP-BC
Other - Prefix:MRS
Other - First Name:TERRY
Other - Middle Name:ANN
Other - Last Name:FINIKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AGNP-BC
Mailing Address - Street 1:20658 STONE OAK PARKWAY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258
Mailing Address - Country:US
Mailing Address - Phone:210-403-3220
Mailing Address - Fax:210-403-3221
Practice Address - Street 1:20658 STONE OAK PARKWAY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258
Practice Address - Country:US
Practice Address - Phone:210-403-3220
Practice Address - Fax:210-403-3221
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-09
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX876247163W00000X
NY542581-1163W00000X
TXAP129385363LG0600X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology