Provider Demographics
NPI:1194941336
Name:BOYD, THERESE ANN (ARNP, EDD)
Entity type:Individual
Prefix:MS
First Name:THERESE
Middle Name:ANN
Last Name:BOYD
Suffix:
Gender:F
Credentials:ARNP, EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10073 NW 13TH CT
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-6572
Mailing Address - Country:US
Mailing Address - Phone:954-476-7441
Mailing Address - Fax:
Practice Address - Street 1:3000 NE 151ST ST
Practice Address - Street 2:FLORIDA INTERNATIONAL UNIVERSITY STUDENT HEALTH CLINIC
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33181-3605
Practice Address - Country:US
Practice Address - Phone:305-919-5620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL66573-2363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL66573-2OtherARNP LICENSE NUMBER