Provider Demographics
NPI:1457904104
Name:TERRELL, BRIANNE ANTOINETTE
Entity type:Individual
Prefix:
First Name:BRIANNE
Middle Name:ANTOINETTE
Last Name:TERRELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BRIANNE
Other - Middle Name:ANTOINETTE
Other - Last Name:YINGLING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11321 W BELL RD STE 401
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85378-9373
Mailing Address - Country:US
Mailing Address - Phone:623-583-2523
Mailing Address - Fax:
Practice Address - Street 1:11321 W BELL RD
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85378-9363
Practice Address - Country:US
Practice Address - Phone:623-583-2523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-22
Last Update Date:2024-08-28
Deactivation Date:2019-10-10
Deactivation Code:
Reactivation Date:2019-10-18
Provider Licenses
StateLicense IDTaxonomies
AZ229685363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health