MEDICARE: MRS. ANDREA JANE VIRGILI

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
1	363LW0102X	Women's Health Nurse Practitioner	ARNP9247104	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1124452966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANDREA JANE VIRGILI

Provider Business Mailing Address
First Line	:	122 MOBBLY BAY DR
Second Line	:
City	:	OLDSMAR
State	:	FL
Zip	:	34677-4014
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	122 MOBBLY BAY DR
Second Line	:
City	:	OLDSMAR
State	:	FL
Zip	:	34677-4014
Country	:	US
Telephone Number	:	813-943-7164
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2013
Last Update Date	:	07/11/2014

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