Provider Demographics
NPI:1528723210
Name:DINETTA, ANDREA MARIE
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:MARIE
Last Name:DINETTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANDEA
Other - Middle Name:
Other - Last Name:LANDAU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2010 PARKSIDE CIR S
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-8569
Mailing Address - Country:US
Mailing Address - Phone:201-906-7281
Mailing Address - Fax:
Practice Address - Street 1:9980 CENTRAL PARK BLVD N STE 304
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-1704
Practice Address - Country:US
Practice Address - Phone:561-483-8335
Practice Address - Fax:561-483-1756
Is Sole Proprietor?:No
Enumeration Date:2021-11-08
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11008918363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily