Provider Demographics
NPI:1790011849
Name:FLANIGAN, TERRY A (NP)
Entity Type:Individual
Prefix:MS
First Name:TERRY
Middle Name:A
Last Name:FLANIGAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:TERRY
Other - Middle Name:A
Other - Last Name:DRAGICH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:72780 COUNTRY CLUB DR
Mailing Address - Street 2:BLDG C 302
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-4126
Mailing Address - Country:US
Mailing Address - Phone:760-346-4299
Mailing Address - Fax:760-776-4042
Practice Address - Street 1:72780 COUNTRY CLUB DR
Practice Address - Street 2:BLDG C 302
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-4126
Practice Address - Country:US
Practice Address - Phone:760-346-4299
Practice Address - Fax:760-776-4042
Is Sole Proprietor?:No
Enumeration Date:2009-10-26
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA399952163W00000X, 163W00000X
CANP95001378363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1790011849Medicaid
WI543300094Medicare PIN