Provider Demographics
NPI:1689632580
Name:HASKINS, TERRI DOREEN (NP (FAMILY NURSE PRA)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:DOREEN
Last Name:HASKINS
Suffix:
Gender:F
Credentials:NP (FAMILY NURSE PRA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1445 PORTLAND AVENUE
Mailing Address - Street 2:SUITE 309
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-3008
Mailing Address - Country:US
Mailing Address - Phone:585-342-2638
Mailing Address - Fax:585-730-7500
Practice Address - Street 1:293 WEST NORTH STREET
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456-1530
Practice Address - Country:US
Practice Address - Phone:585-398-2420
Practice Address - Fax:585-730-7500
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF334820-1363LF0000X
NY507548364S00000X
NY334820363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02749957Medicaid
NYJ400004348Medicare PIN