Provider Demographics
NPI:1144322637
Name:THORPE, ANDREA JENNIFER (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:JENNIFER
Last Name:THORPE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 N CLYDE MORRIS BLVD
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-2709
Mailing Address - Country:US
Mailing Address - Phone:386-947-3553
Mailing Address - Fax:386-239-6189
Practice Address - Street 1:303 N CLYDE MORRIS BLVD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-2709
Practice Address - Country:US
Practice Address - Phone:386-947-3553
Practice Address - Fax:386-239-6189
Is Sole Proprietor?:No
Enumeration Date:2006-09-04
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME50126208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME50126OtherSTATE MEDICAL LICENSE
FL063123003Medicaid
E66568Medicare UPIN
FLME50126OtherSTATE MEDICAL LICENSE