Provider Demographics
NPI:1902966336
Name:BIANCHI, TERRI L (ARNP)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:L
Last Name:BIANCHI
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 1:305 CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-8181
Mailing Address - Country:US
Mailing Address - Phone:386-615-1771
Mailing Address - Fax:386-615-1545
Practice Address - Street 1:305 CLYDE MORRIS BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-8181
Practice Address - Country:US
Practice Address - Phone:386-615-1771
Practice Address - Fax:386-615-1545
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2065042363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY0650OtherBLUE CROSS BLUE SHIELD
FLY0650OtherBLUE CROSS BLUE SHIELD
FLS77514Medicare UPIN