Provider Demographics
NPI:1457703183
Name:MCLEAN, TERESA MARIE (ARNP-BC)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:MARIE
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:ARNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4611 NW 53RD AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32653-4898
Mailing Address - Country:US
Mailing Address - Phone:352-371-0301
Mailing Address - Fax:352-371-4635
Practice Address - Street 1:4200 NW 90TH BLVD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-3809
Practice Address - Country:US
Practice Address - Phone:352-378-2121
Practice Address - Fax:352-379-6206
Is Sole Proprietor?:No
Enumeration Date:2016-07-06
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9357114363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020177500Medicaid