Provider Demographics
NPI:1689633836
Name:ALLRED, TERRI PAM (ARNP)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:PAM
Last Name:ALLRED
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4958 SUN N LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33872-2167
Mailing Address - Country:US
Mailing Address - Phone:863-386-4711
Mailing Address - Fax:863-386-4301
Practice Address - Street 1:4958 SUN N LAKE BLVD
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33872-2167
Practice Address - Country:US
Practice Address - Phone:863-386-4711
Practice Address - Fax:863-386-4301
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3395352363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL311421000Medicaid