MEDICARE: MRS. ANDREA MARIA PENA NP

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	363LF0000X	Family Nurse Practitioner	APRN11003313	FL

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	:	1538716311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANDREA MARIA PENA NP

Provider Business Mailing Address
First Line	:	5555 PONCE DE LEON BLVD
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33146-2513
Country	:	US
Telephone Number	:	305-243-7429
Fax Number	:

Provider Business Practice Location Address
First Line	:	1150 NW 14TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33136-2137
Country	:	US
Telephone Number	:	305-243-1010
Fax Number	:	305-243-1019

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

Provider Enumeration Date	:	08/26/2019
Last Update Date	:	06/02/2026

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