Provider Demographics
NPI:1588491781
Name:CHINTALA, ANNDRA (APRN)
Entity type:Individual
Prefix:
First Name:ANNDRA
Middle Name:
Last Name:CHINTALA
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 1:9594 CAMPI DR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-6997
Mailing Address - Country:US
Mailing Address - Phone:646-670-2586
Mailing Address - Fax:
Practice Address - Street 1:9594 CAMPI DR
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-6997
Practice Address - Country:US
Practice Address - Phone:646-670-2586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-19
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11035270363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily