Provider Demographics
NPI:1407817059
Name:SCHREIBER, TERRY R (CRNA)
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:R
Last Name:SCHREIBER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 GROOVER LOOP
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-6564
Mailing Address - Country:US
Mailing Address - Phone:904-824-6108
Mailing Address - Fax:
Practice Address - Street 1:216 SOUTHPARK CIR E
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5135
Practice Address - Country:US
Practice Address - Phone:904-824-6108
Practice Address - Fax:904-823-9613
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-31
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1859492367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL301291300Medicaid