Healthcare Provider Details

I. General information

NPI: 1184955239
Provider Name (Legal Business Name): ANDREA RERECICH ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2010
Last Update Date: 03/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3505 SHILOH DR
WEST PALM BEACH FL
33407-6870
US

IV. Provider business mailing address

2601 10TH AVE N SUITE 100
PALM SPRINGS FL
33461-3141
US

V. Phone/Fax

Practice location:
  • Phone: 561-242-5443
  • Fax:
Mailing address:
  • Phone: 561-642-1008
  • Fax: 561-802-3976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberARNP3183512
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: