Healthcare Provider Details

I. General information

NPI: 1205188612
Provider Name (Legal Business Name): ANDREA MARIE FALCON APRN-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2012
Last Update Date: 09/22/2022
Certification Date: 09/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3610 GALILEO DR STE 102
TRINITY FL
34655-1794
US

IV. Provider business mailing address

7547 JACQUE RD
HUDSON FL
34667-7163
US

V. Phone/Fax

Practice location:
  • Phone: 813-406-4835
  • Fax: 813-994-4835
Mailing address:
  • Phone: 727-862-8561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9241414
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: