Provider Demographics
NPI:1992093470
Name:PERRY, ANDREA (ARNP)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:PERRY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 310754
Mailing Address - Street 2:DEPT 4101
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-0754
Mailing Address - Country:US
Mailing Address - Phone:561-622-6111
Mailing Address - Fax:561-244-2591
Practice Address - Street 1:411 W INDIANTOWN RD
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-3538
Practice Address - Country:US
Practice Address - Phone:561-622-6111
Practice Address - Fax:561-244-2591
Is Sole Proprietor?:No
Enumeration Date:2011-07-18
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1188552363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFN416ZMedicare PIN