Provider Demographics
NPI:1194983718
Name:MOORE, ANDREA PIERCE (AUD, CCC-A, F-AAA)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:PIERCE
Last Name:MOORE
Suffix:
Gender:F
Credentials:AUD, CCC-A, F-AAA
Other - Prefix:DR
Other - First Name:ANDREA
Other - Middle Name:DAWN
Other - Last Name:PIERCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD, CCC-A, F-AAA
Mailing Address - Street 1:11945 SAN JOSE BLVD
Mailing Address - Street 2:#300
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-1613
Mailing Address - Country:US
Mailing Address - Phone:904-396-1725
Mailing Address - Fax:904-399-1717
Practice Address - Street 1:4203 BELFORT RD
Practice Address - Street 2:SUITE 340
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-1409
Practice Address - Country:US
Practice Address - Phone:904-880-0911
Practice Address - Fax:904-880-9388
Is Sole Proprietor?:No
Enumeration Date:2008-05-30
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY1430231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLEW633YMedicare PIN