Healthcare Provider Details

I. General information

NPI: 1841364577
Provider Name (Legal Business Name): ANDREA M PRINCE M. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 08/25/2021
Certification Date: 08/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8409 SW 80TH ST STE 8
OCALA FL
34481-9117
US

IV. Provider business mailing address

8409 SW 80TH ST STE 8
OCALA FL
34481-9117
US

V. Phone/Fax

Practice location:
  • Phone: 352-414-1922
  • Fax: 844-388-6186
Mailing address:
  • Phone: 352-414-1922
  • Fax: 844-388-6186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME150481
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number14807
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: