Provider Demographics
NPI:1598318024
Name:ROESSLER-KENNEDY, TERI (APRN)
Entity Type:Individual
Prefix:
First Name:TERI
Middle Name:
Last Name:ROESSLER-KENNEDY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23343 NW COUNTY ROAD 236
Mailing Address - Street 2:
Mailing Address - City:HIGH SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32643-9669
Mailing Address - Country:US
Mailing Address - Phone:386-454-0698
Mailing Address - Fax:386-454-0690
Practice Address - Street 1:211 RANCHERA ST NW
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:FL
Practice Address - Zip Code:32064-4866
Practice Address - Country:US
Practice Address - Phone:386-364-1751
Practice Address - Fax:386-364-1761
Is Sole Proprietor?:No
Enumeration Date:2019-07-23
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9367203163WG0000X
FLAPRN11004324363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice