Provider Demographics
NPI:1558925446
Name:EVERETT, TERRIE (BS)
Entity Type:Individual
Prefix:
First Name:TERRIE
Middle Name:
Last Name:EVERETT
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 NW 167TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33056-4838
Mailing Address - Country:US
Mailing Address - Phone:305-624-7450
Mailing Address - Fax:305-623-7893
Practice Address - Street 1:635 SW 14TH TER
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-7251
Practice Address - Country:US
Practice Address - Phone:786-356-1253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-25
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management