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NPI Code Detail

MEDICARE: ANDREA MARK

MEDICARE: ANDREA MARK
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13747P1801XPersonal Care Attendant
2106S00000XBehavior Technician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1023553450
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREA MARK
Provider Business Mailing Address
First Line : 10081 NW 3RD CT
Second Line :
City : PLANTATION
State : FL
Zip : 33324-7049
Country : US
Telephone Number : 954-236-4631
Fax Number :
Provider Business Practice Location Address
First Line : 10081 NW 3RD CT
Second Line :
City : PLANTATION
State : FL
Zip : 33324-7049
Country : US
Telephone Number : 954-236-4631
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/20/2016
Last Update Date : 10/17/2017

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Directions to “ ANDREA MARK ” Practice Location

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