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General NPI Number Information
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NPI Number | 1902057607
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Entity Type | Individual
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Provider Name | MARINA ANDROSSOVA M.D.
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Gender | Female
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Dates
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Enumeration Date | 10/01/2008
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Last Update Date | 01/12/2023
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Provider Practice Location Address
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Address Line | 11380 SW VILLAGE PKWY
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City | PORT ST LUCIE
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State | FL
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Zip | 34987-2388
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Country | US
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Telephone | 772-301-6565
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Fax | 843-777-5135
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Provider Business Mailing Address
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Address Line | 11380 SW VILLAGE PKWY
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City | PORT ST LUCIE
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State | FL
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Zip | 34987-2388
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Country | US
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Telephone | 772-301-6565
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Fax | 843-777-5135
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Internal Medicine) Physician
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License Number | ME160289
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License Number State | FL
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