Provider Demographics
NPI:1598091365
Name:DELONGCHAMP, TERESA ANN (CRNA)
Entity Type:Individual
Prefix:MISS
First Name:TERESA
Middle Name:ANN
Last Name:DELONGCHAMP
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4828 N DAVIS HWY
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2341
Mailing Address - Country:US
Mailing Address - Phone:850-477-8109
Mailing Address - Fax:850-476-5313
Practice Address - Street 1:4810 N DAVIS HWY
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503
Practice Address - Country:US
Practice Address - Phone:850-474-8988
Practice Address - Fax:850-476-5312
Is Sole Proprietor?:No
Enumeration Date:2009-10-28
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9444717367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022648800Medicaid
FLUP4FCOtherBCBS