Provider Demographics
NPI:1942240288
Name:GROOVER, TERESA C (APRN)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:C
Last Name:GROOVER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MRS
Other - First Name:TERESA
Other - Middle Name:L
Other - Last Name:MCKINNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:3280 W AUDUBON PARK PATH
Mailing Address - Street 2:
Mailing Address - City:LECANTO
Mailing Address - State:FL
Mailing Address - Zip Code:34461-8450
Mailing Address - Country:US
Mailing Address - Phone:352-527-2020
Mailing Address - Fax:352-527-0386
Practice Address - Street 1:3264 W AUDUBON PARK PATH
Practice Address - Street 2:
Practice Address - City:LECANTO
Practice Address - State:FL
Practice Address - Zip Code:34461-8450
Practice Address - Country:US
Practice Address - Phone:352-527-2020
Practice Address - Fax:352-527-0386
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9299465363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAQ07582Medicare UPIN
GA50BBHFKMedicare ID - Type Unspecified