Provider Demographics
NPI:1285697920
Name:HARRISON, ANDREA SUZANNE (ATC/L)
Entity type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:SUZANNE
Last Name:HARRISON
Suffix:
Gender:F
Credentials:ATC/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 THOMPSON CIR NW
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-2360
Mailing Address - Country:US
Mailing Address - Phone:954-290-7491
Mailing Address - Fax:
Practice Address - Street 1:1768 PARK CENTER DR
Practice Address - Street 2:STE. 200
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-6200
Practice Address - Country:US
Practice Address - Phone:407-352-1550
Practice Address - Fax:407-447-7582
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL13782255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAL1378OtherATHLETIC TRAINING LICENSE