Healthcare Provider Details

I. General information

NPI: 1487969101
Provider Name (Legal Business Name): ANDREA L KICHLINE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2010
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

985 STATE ROAD 436
CASSELBERRY FL
32707-5664
US

IV. Provider business mailing address

5557 RUTHERFORD PL
OVIEDO FL
32765-3420
US

V. Phone/Fax

Practice location:
  • Phone: 407-831-5252
  • Fax: 407-831-3765
Mailing address:
  • Phone: 941-345-3045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN9224467
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP9224467
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: