Healthcare Provider Details

I. General information

NPI: 1932523925
Provider Name (Legal Business Name): ANDREA MCGLONE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2014
Last Update Date: 04/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 W CYPRESS CREEK RD SUITE C100
FT LAUDERDALE FL
33309-1744
US

IV. Provider business mailing address

2700 W CYPRESS CREEK RD SUITE C100
FT LAUDERDALE FL
33309-1744
US

V. Phone/Fax

Practice location:
  • Phone: 954-974-3111
  • Fax: 954-974-6191
Mailing address:
  • Phone: 954-974-3111
  • Fax: 954-974-6191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9107716
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: