Provider Demographics
NPI:1568938488
Name:HOUSE, ANDREA MARCELA (PMHNP-BC, APRN, MSN)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:MARCELA
Last Name:HOUSE
Suffix:
Gender:
Credentials:PMHNP-BC, APRN, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12412 SAN JOSE BLVD STE 304D
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-8620
Mailing Address - Country:US
Mailing Address - Phone:904-706-1551
Mailing Address - Fax:888-440-2789
Practice Address - Street 1:12412 SAN JOSE BLVD STE 304D
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-8620
Practice Address - Country:US
Practice Address - Phone:904-706-1551
Practice Address - Fax:888-440-2789
Is Sole Proprietor?:No
Enumeration Date:2018-10-18
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9334235163W00000X
FLAPRN11032921363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse