Provider Demographics
NPI:1912429713
Name:MOLINA, ANDREA NICOLE
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:NICOLE
Last Name:MOLINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 E ALTAMONTE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-4824
Mailing Address - Country:US
Mailing Address - Phone:407-303-5465
Mailing Address - Fax:407-303-5467
Practice Address - Street 1:711 E ALTAMONTE DR STE 200
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-4824
Practice Address - Country:US
Practice Address - Phone:407-303-5465
Practice Address - Fax:407-303-5467
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA59579225700000X
224Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist