Provider Demographics
NPI:1861058745
Name:MUGGLI, ANDREA CLAIRE (APRN)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:CLAIRE
Last Name:MUGGLI
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11380 SW VILLAGE PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987-2389
Mailing Address - Country:US
Mailing Address - Phone:772-301-6500
Mailing Address - Fax:
Practice Address - Street 1:11380 SW VILLAGE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34987-2389
Practice Address - Country:US
Practice Address - Phone:772-301-6500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-15
Last Update Date:2023-09-12
Deactivation Date:2023-09-06
Deactivation Code:
Reactivation Date:2023-09-12
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11000485363LF0000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty