Provider Demographics
NPI:1558870329
Name:SCANLAN, TERESA ANN (NP-C)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:ANN
Last Name:SCANLAN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:ANN
Other - Last Name:STEVERMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:620 10TH ST N STE 2A
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-1407
Mailing Address - Country:US
Mailing Address - Phone:727-824-8243
Mailing Address - Fax:
Practice Address - Street 1:620 10TH ST N STE 2A
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-1407
Practice Address - Country:US
Practice Address - Phone:727-824-8243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-25
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5428363LF0000X
FL11017893207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily