Provider Demographics
NPI:1104871706
Name:RUSH, TERRIE LYNN (ARNP)
Entity type:Individual
Prefix:
First Name:TERRIE
Middle Name:LYNN
Last Name:RUSH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:TERRIE
Other - Middle Name:LYNN
Other - Last Name:BROWNING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 919424
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32891
Mailing Address - Country:US
Mailing Address - Phone:863-816-5884
Mailing Address - Fax:
Practice Address - Street 1:4315 HIGHLAND PARK BLVD STE D
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-1639
Practice Address - Country:US
Practice Address - Phone:813-651-1085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS45832363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS161710OtherBLUE SHIELD
KS200401900AMedicaid
Q70025Medicare UPIN
161710Medicare ID - Type Unspecified