Healthcare Provider Details

I. General information

NPI: 1720638273
Provider Name (Legal Business Name): ANDREA MARIE MEKULIK APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2019
Last Update Date: 01/22/2024
Certification Date: 01/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1690 S FEDERAL HWY
DELRAY BEACH FL
33483-5030
US

IV. Provider business mailing address

3720 EXECUTIVE WAY
MIRAMAR FL
33025-3946
US

V. Phone/Fax

Practice location:
  • Phone: 561-272-1163
  • Fax:
Mailing address:
  • Phone: 877-868-4827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9332046
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: