Healthcare Provider Details

I. General information

NPI: 1780215673
Provider Name (Legal Business Name): ANDREW CISTOLA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2020
Last Update Date: 01/29/2020
Certification Date: 01/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 SE 24TH ST
GAINESVILLE FL
32641-7516
US

IV. Provider business mailing address

224 SE 24TH ST
GAINESVILLE FL
32641-7516
US

V. Phone/Fax

Practice location:
  • Phone: 352-334-7962
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: