Provider Demographics
NPI:1215165402
Name:TERRANOVA, KRISTEN NICOLE (DO)
Entity type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:NICOLE
Last Name:TERRANOVA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 MEADOW POND CT
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-9827
Mailing Address - Country:US
Mailing Address - Phone:614-871-7141
Mailing Address - Fax:
Practice Address - Street 1:3000 MEADOW POND CT
Practice Address - Street 2:SUITE 100
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-9827
Practice Address - Country:US
Practice Address - Phone:614-871-7141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-25
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34010981207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH220530OtherMEDICARE PTAN