Terryl A. Polanin, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

277-000264 Issued in IL

Practice address

2321 N Wisconsin Ave
Peoria, IL 61603-5613

Phone

(309) 680-7600

Fax

(309) 681-4681

NPI assigned

Oct 15, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Terryl A Bush Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160870400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583884800000",
    "number": "1235229535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2214 N UNIVERSITY ST",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616043221",
            "telephone_number": "309-680-7669",
            "fax_number": "309-681-8443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2321 N WISCONSIN AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616035613",
            "telephone_number": "309-680-7600",
            "fax_number": "309-681-4681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLANIN",
        "first_name": "TERRYL",
        "middle_name": "A.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-15",
        "last_updated": "2020-03-11",
        "certification_date": "2020-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "041162013/209000866",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "277-000264",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TERRYL",
            "last_name": "BUSH",
            "middle_name": "A",
            "credential": "FNP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Patricia A Poertner, LCPC
• Edith Marie Pohland, LCP
• Pointcore, Inc. (OSF Pharmacy)
• Pointcore, Inc. (Medipark Pharmacy)
• Pointcore, Inc. (OSF Specialty Pharmacy)
• Brooke Poling, LCPC
• Stephanie A Polka, PHYSICAL THERAPIST
• Robert Michael Pollard, DDS
• Eric Polomis
• Lauren S Ponder, APN

• Family Nurse Practitioner in Peoria, IL
• Providers in Peoria, IL by specialty
• Family Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.