Healthcare Provider Details

I. General information

NPI: 1750920567
Provider Name (Legal Business Name): ANDREMENE JOSEPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2019
Last Update Date: 12/26/2019
Certification Date: 12/26/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2490 AMBASSADOR AVE
SPRING HILL FL
34609-4505
US

IV. Provider business mailing address

2490 AMBASSADOR AVE
SPRING HILL FL
34609-4505
US

V. Phone/Fax

Practice location:
  • Phone: 352-340-4642
  • Fax:
Mailing address:
  • Phone: 352-340-4642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: