Provider Demographics
NPI:1417602087
Name:DORN, TERRI LYNN (MSN, APRN)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:LYNN
Last Name:DORN
Suffix:
Gender:F
Credentials:MSN, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14665 WILDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33774-4819
Mailing Address - Country:US
Mailing Address - Phone:910-987-5902
Mailing Address - Fax:
Practice Address - Street 1:12150 SEMINOLE BLVD
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33778-2833
Practice Address - Country:US
Practice Address - Phone:727-216-6188
Practice Address - Fax:727-216-6242
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-12
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11021101363LF0000X
FL9487516163W00000X
FLRN9487516363LF0000X
FLAPRN11021101363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse