MEDICARE: ANDREA GAY STOLL RNFA

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	163W00000X	Registered Nurse	RN3153272	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Y037M	OTHER	FL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1184705337
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA GAY STOLL RNFA

Provider Business Mailing Address
First Line	:	14536 80TH STREET NORTH
Second Line	:
City	:	LOXATCHEE
State	:	FL
Zip	:	33470
Country	:	US
Telephone Number	:	561-784-0427
Fax Number	:	866-277-6962

Provider Business Practice Location Address
First Line	:	1128-253 ROYAL PALM BEACH BLVD
Second Line	:
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33411
Country	:	US
Telephone Number	:	561-784-0427
Fax Number	:	866-277-6962

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

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	07/08/2007

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