Provider Demographics
NPI:1528739778
Name:VINSON, ANDREA MICHELLE
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:MICHELLE
Last Name:VINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4013 DEERWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-1108
Mailing Address - Country:US
Mailing Address - Phone:850-426-8746
Mailing Address - Fax:
Practice Address - Street 1:4013 DEERWOOD CIR
Practice Address - Street 2:
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571-1108
Practice Address - Country:US
Practice Address - Phone:850-426-8746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider