Provider Demographics
NPI:1861147282
Name:TERVEER, TAYLOR NICOLE (FNP)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:NICOLE
Last Name:TERVEER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 MEADOW RUE DR
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-3139
Mailing Address - Country:US
Mailing Address - Phone:618-975-8453
Mailing Address - Fax:
Practice Address - Street 1:4955 S STATE ROUTE 159 STE 1
Practice Address - Street 2:
Practice Address - City:GLEN CARBON
Practice Address - State:IL
Practice Address - Zip Code:62034-1907
Practice Address - Country:US
Practice Address - Phone:182-887-8556
Practice Address - Fax:618-288-7866
Is Sole Proprietor?:No
Enumeration Date:2022-02-14
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2021049491363LF0000X
IL209025656363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily