Healthcare Provider Details

I. General information

NPI: 1295821387
Provider Name (Legal Business Name): MS. ANDREA LYNN MARION
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 11/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17615 SW 97TH AVE
PALMETTO BAY FL
33157-5636
US

IV. Provider business mailing address

2514 LINDA AVE REAR APT
KEY WEST FL
33040-5114
US

V. Phone/Fax

Practice location:
  • Phone: 786-268-2611
  • Fax: 786-268-1748
Mailing address:
  • Phone: 305-731-9218
  • Fax: 866-903-4377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: