Provider Demographics
NPI:1265512628
Name:FOWLER-PLOTKIN, TERESA ANN (CRNA)
Entity type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:ANN
Last Name:FOWLER-PLOTKIN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 491529
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34749-1529
Mailing Address - Country:US
Mailing Address - Phone:407-468-0065
Mailing Address - Fax:866-339-1813
Practice Address - Street 1:600 E DIXIE AVE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-5925
Practice Address - Country:US
Practice Address - Phone:407-468-0065
Practice Address - Fax:866-339-1813
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3013662367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered