Provider Demographics
NPI:1487969101
Name:KICHLINE, ANDREA L (APRN)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:L
Last Name:KICHLINE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5557 RUTHERFORD PL
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-3420
Mailing Address - Country:US
Mailing Address - Phone:941-345-3045
Mailing Address - Fax:
Practice Address - Street 1:985 STATE ROAD 436
Practice Address - Street 2:
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-5664
Practice Address - Country:US
Practice Address - Phone:407-831-5252
Practice Address - Fax:407-831-3765
Is Sole Proprietor?:No
Enumeration Date:2010-08-18
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9224467363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP9224467OtherLICENSE NUMBER
FL008895500Medicaid
FLP00960447OtherRAILROAD MEDICARE
FLDO005XMedicare PIN
FL008895500Medicaid
FLDO005ZMedicare PIN