Individual
TERESA K MAHAN-ETHERIDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
3100 E FLETCHER AVE, TAMPA, FL 33613-4613
(813) 467-4770
(813) 467-4243
Mailing address
3100 E FLETCHER AVE, TAMPA, FL 33613-4613
(813) 467-4770
(813) 467-4243
Taxonomy
Speciality
Code
Description
License number
State
363LN0000X
Neonatal Nurse Practitioner
Primary
APRN9208090
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003148500
—
FL
01
—
Y06M3
BLUE CROSS BLUE SHIELD
FL
Enumeration date
01/25/2011
Last updated
05/23/2025
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