Healthcare Provider Details

I. General information

NPI: 1639292915
Provider Name (Legal Business Name): ANDREA WEISS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10246 SHADOW BRANCH DR
TAMPA FL
33647-3116
US

IV. Provider business mailing address

10246 SHADOW BRANCH DR
TAMPA FL
33647-3116
US

V. Phone/Fax

Practice location:
  • Phone: 181-399-1623
  • Fax:
Mailing address:
  • Phone: 181-399-1623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN 3410042
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: