Provider Demographics
NPI:1740591346
Name:TERRY, DEVIN KIMBERLY (CNS, RN)
Entity Type:Individual
Prefix:
First Name:DEVIN
Middle Name:KIMBERLY
Last Name:TERRY
Suffix:
Gender:F
Credentials:CNS, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12425 RACE TRACK RD
Mailing Address - Street 2:SUITE #100
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-3102
Mailing Address - Country:US
Mailing Address - Phone:800-876-0922
Mailing Address - Fax:800-766-7713
Practice Address - Street 1:12425 RACE TRACK RD
Practice Address - Street 2:SUITE #100
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-3102
Practice Address - Country:US
Practice Address - Phone:800-876-0922
Practice Address - Fax:800-766-7713
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-29
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR69599163W00000X
ARS02226 CNS174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No163W00000XNursing Service ProvidersRegistered Nurse