Provider Demographics
NPI:1396854386
Name:MACGREGOR, TERESA L (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:L
Last Name:MACGREGOR
Suffix:
Gender:F
Credentials:ARNP
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Mailing Address - Street 1:PO BOX 44008
Mailing Address - Street 2:UFJP - PROVIDER ENROLLMENT
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:904-244-3199
Mailing Address - Fax:904-244-3425
Practice Address - Street 1:836 PRUDENTIAL DRIVE
Practice Address - Street 2:UFJAX - DEPARTMENT OF NEUROSURGERY (PEDIATRIC)
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207
Practice Address - Country:US
Practice Address - Phone:904-633-0780
Practice Address - Fax:904-633-0781
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2014-10-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLARNP2869412363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA484245896CMedicaid
GA484245896AMedicaid
GA484245896DMedicaid
FL3072258000Medicaid
GA484245896CMedicaid
FLAH374ZMedicare PIN
GA484245896AMedicaid
FLAH374XMedicare PIN