Provider Demographics
NPI:1063075745
Name:WANCY, ANDRECILE F (CNA)
Entity type:Individual
Prefix:
First Name:ANDRECILE
Middle Name:F
Last Name:WANCY
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4739 CAMBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33463-2267
Mailing Address - Country:US
Mailing Address - Phone:561-531-4628
Mailing Address - Fax:561-342-8995
Practice Address - Street 1:100 E LINTON BLVD STE 116B
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-3341
Practice Address - Country:US
Practice Address - Phone:561-420-6842
Practice Address - Fax:561-342-8995
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-17
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
372500000X, 372600000X, 376J00000X, 374U00000X
FLCNA90706376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No376J00000XNursing Service Related ProvidersHomemaker
No376K00000XNursing Service Related ProvidersNurse's Aide