Healthcare Provider Details

I. General information

NPI: 1841576139
Provider Name (Legal Business Name): ANDRENA M MCGROARTY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2011
Last Update Date: 10/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6804 CECELIA DR
NEW PORT RICHEY FL
34653-4935
US

IV. Provider business mailing address

6804 CECELIA DR
NEW PORT RICHEY FL
34653-4935
US

V. Phone/Fax

Practice location:
  • Phone: 855-232-0644
  • Fax: 888-546-0488
Mailing address:
  • Phone: 855-232-0644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number24199
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11003844
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: