Provider Demographics
NPI:1255621579
Name:PARSON, ANDREA (CNA/MA)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:
Last Name:PARSON
Suffix:
Gender:F
Credentials:CNA/MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 WASHINGTON CIR APT D
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33034-3671
Mailing Address - Country:US
Mailing Address - Phone:516-589-9440
Mailing Address - Fax:
Practice Address - Street 1:1017 WASHIMGTON CIR APT D
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33403
Practice Address - Country:US
Practice Address - Phone:516-589-9440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-08
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL311500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)