Provider Demographics
NPI:1720074784
Name:DEFILIPPO, TERRY ANN (CNM)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:ANN
Last Name:DEFILIPPO
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6853 SW 18TH ST
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-7056
Mailing Address - Country:US
Mailing Address - Phone:561-368-3775
Mailing Address - Fax:561-368-1143
Practice Address - Street 1:6853 SW 18TH ST
Practice Address - Street 2:STE 301
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-7056
Practice Address - Country:US
Practice Address - Phone:561-368-3775
Practice Address - Fax:561-368-1143
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1013732367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
P09767Medicare UPIN
Y37412Medicare ID - Type Unspecified