Provider Demographics
NPI:1508088345
Name:BISHOP, TERRI (CNM, ARNP)
Entity Type:Individual
Prefix:MS
First Name:TERRI
Middle Name:
Last Name:BISHOP
Suffix:
Gender:F
Credentials:CNM, ARNP
Other - Prefix:MRS
Other - First Name:THERESA
Other - Middle Name:BISHOP
Other - Last Name:WHITEHURST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM, ARNP
Mailing Address - Street 1:1128 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401
Mailing Address - Country:US
Mailing Address - Phone:850-258-1514
Mailing Address - Fax:850-747-8001
Practice Address - Street 1:7051 SOUTHPOINT PKWY S STE 200
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216
Practice Address - Country:US
Practice Address - Phone:904-493-2229
Practice Address - Fax:904-396-4546
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9201376363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP 9201376OtherFL LICENSE NUMBER
CERTIFICATION# 11137OtherAMER. MIDWIFERY CERT. BD.