Healthcare Provider Details

I. General information

NPI: 1578938734
Provider Name (Legal Business Name): ANDREA NICOLE RISTAINO FNP- BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2015
Last Update Date: 10/23/2023
Certification Date: 10/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6646 ATLANTIC AVE STE 100
DELRAY BEACH FL
33446-1627
US

IV. Provider business mailing address

7593 W BOYNTON BEACH BLVD STE 220
BOYNTON BEACH FL
33437-6162
US

V. Phone/Fax

Practice location:
  • Phone: 561-638-9533
  • Fax: 561-638-7760
Mailing address:
  • Phone: 561-678-2652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9308855
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: