Healthcare Provider Details

I. General information

NPI: 1194727644
Provider Name (Legal Business Name): ANDREA CHANCE STARK ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13475 SOUTHERN BLVD STE 202
LOXAHATCHEE FL
33470-9234
US

IV. Provider business mailing address

2000 PALM BEACH LAKES BLVD STE 901
WEST PALM BEACH FL
33409-6506
US

V. Phone/Fax

Practice location:
  • Phone: 561-509-5009
  • Fax: 561-798-2733
Mailing address:
  • Phone: 561-509-5009
  • Fax: 561-738-1822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberARNP 2587202
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN2587202
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: