Provider Demographics
NPI:1568623361
Name:TERENZI, EGILDA ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:EGILDA
Middle Name:ANN
Last Name:TERENZI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4202 E FOWLER AVE
Mailing Address - Street 2:SHS100
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33620-9951
Mailing Address - Country:US
Mailing Address - Phone:813-974-1815
Mailing Address - Fax:813-974-8391
Practice Address - Street 1:4202 E FOWLER AVE
Practice Address - Street 2:SHS100
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33620-9951
Practice Address - Country:US
Practice Address - Phone:813-974-1815
Practice Address - Fax:813-974-8391
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0046301208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000185900Medicaid
FL08324OtherBLUE CROSS BLUE SHIELD
FL08324ZMedicare PIN