Provider Demographics
NPI:1477210094
Name:TOMPKINS, TERA DIONNE (RN)
Entity Type:Individual
Prefix:
First Name:TERA
Middle Name:DIONNE
Last Name:TOMPKINS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4996 CORRADO AVE
Mailing Address - Street 2:
Mailing Address - City:AVE MARIA
Mailing Address - State:FL
Mailing Address - Zip Code:34142-4666
Mailing Address - Country:US
Mailing Address - Phone:954-815-0060
Mailing Address - Fax:
Practice Address - Street 1:4996 CORRADO AVE
Practice Address - Street 2:
Practice Address - City:AVE MARIA
Practice Address - State:FL
Practice Address - Zip Code:34142-4666
Practice Address - Country:US
Practice Address - Phone:954-815-0060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9303299163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-SurgicalGroup - Multi-Specialty