Healthcare Provider Details

I. General information

NPI: 1619452844
Provider Name (Legal Business Name): ANDREA MARIE ANTELO ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2018
Last Update Date: 03/10/2021
Certification Date: 03/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6280 SUNSET DR STE 504
SOUTH MIAMI FL
33143-4870
US

IV. Provider business mailing address

10520 SW 125TH ST
MIAMI FL
33176-4728
US

V. Phone/Fax

Practice location:
  • Phone: 305-666-1774
  • Fax:
Mailing address:
  • Phone: 305-213-9922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9387512
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: