Provider Demographics
NPI:1548907058
Name:LEMON, TERRI
Entity type:Individual
Prefix:
First Name:TERRI
Middle Name:
Last Name:LEMON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E BURGESS RD APT 64A
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-7302
Mailing Address - Country:US
Mailing Address - Phone:504-515-2810
Mailing Address - Fax:
Practice Address - Street 1:200 E BURGESS RD APT 64A
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-7302
Practice Address - Country:US
Practice Address - Phone:504-515-2810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-16
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL22000173825374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLL22000173825OtherLLC DOCUMENT