Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | ME76828 | FL |
N | 208000000X | Pediatrician | ME0076828 | FL |
NPI | 1780628560 |
---|---|
Provider Name | Dr. Terry-Ann S Haynes |
First Address | Sunrise, FL 33323-2865 |
Second Address | Hollywood, FL 33021-5421 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 22/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
256042900 | (05) | FL |
46501 | BLUE SHIELD (01) | FL |
G90971 | (02) |