Provider Demographics
NPI:1316511041
Name:MCCLENDON, ANDREA (LPN)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:MCCLENDON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12081 134TH PL
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33778-1012
Mailing Address - Country:US
Mailing Address - Phone:727-688-5883
Mailing Address - Fax:
Practice Address - Street 1:12081 134TH PL
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33778-1012
Practice Address - Country:US
Practice Address - Phone:727-688-5883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5195336164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse