MEDICARE: ANDREA LANDIVAR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician
2	171M00000X	Case Manager/Care Coordinator

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407488299
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA LANDIVAR

Provider Business Mailing Address
First Line	:	300 INTERNATIONAL PKWY STE 200
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-5028
Country	:	US
Telephone Number	:	866-610-0580
Fax Number	:

Provider Business Practice Location Address
First Line	:	3107 N 50TH ST STE A
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33619-2302
Country	:	US
Telephone Number	:	813-466-2236
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/10/2020
Last Update Date	:	09/17/2021

Similar Medicare Providers

1114256070 — MR. DALE MCNITT LCSW
Practice Location Address:

3107 N 50TH ST
TAMPA, FL
33619-2302

Practice Phone: 813-367-2316
Practice Fax:

1073819850 — FOUR SEASONS BEHAVIORAL HEALTH COLLABORATIVE INC.
Practice Location Address:

3107 N 50TH ST STE A
TAMPA, FL
33619-2302

Practice Phone: 813-367-2316
Practice Fax:

1407125735 — DALE MCNITT
Practice Location Address:

3107 N 50TH ST
TAMPA, FL
33619-2302

Practice Phone: 813-763-0659
Practice Fax: 813-367-2312

1689943482 — JOEL BERGMAN
Practice Location Address:

3107 N 50TH ST
TAMPA, FL
33619-2302

Practice Phone: 813-367-2317
Practice Fax: 813-367-2312

1225528136 — D'MARIO HENRY
Practice Location Address:

3107 N 50TH ST
TAMPA, FL
33619-2302

Practice Phone: 813-538-0061
Practice Fax:

1386100246 — DORIS DAY CROMARTIE MA, RMHCI
Practice Location Address:

3107 N 50TH ST STE A
TAMPA, FL
33619-2302

Practice Phone: 813-635-0606
Practice Fax:

Directions to “ ANDREA LANDIVAR ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.