Provider Demographics
NPI:1669062899
Name:DAVID C TERRELL JR ARNP, PA
Entity type:Organization
Organization Name:DAVID C TERRELL JR ARNP, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ARNP
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:TERRELL
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:386-287-2111
Mailing Address - Street 1:4289 NW AMERICAN LN
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32055-4881
Mailing Address - Country:US
Mailing Address - Phone:386-287-2111
Mailing Address - Fax:386-406-8368
Practice Address - Street 1:4289 NW AMERICAN LANE
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055
Practice Address - Country:US
Practice Address - Phone:386-288-2884
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-21
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1811411754OtherTYPE 1 NPI
FLAPRN9330784OtherFLORIDA LICENSE
FL1861018988OtherTYPE 1 NPI
FLAPRN11007399OtherFLORIDA LICENSE