Provider Demographics
NPI:1770566036
Name:MASSARO, TERESA LYNNE (ARNP)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:LYNNE
Last Name:MASSARO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18643 SAN RIO CIR
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33549-3918
Mailing Address - Country:US
Mailing Address - Phone:813-949-2686
Mailing Address - Fax:
Practice Address - Street 1:4200 W CYPRESS ST STE 690
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-4112
Practice Address - Country:US
Practice Address - Phone:813-877-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1377702363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP06824Medicare UPIN
FLE4126ZMedicare ID - Type Unspecified