Provider Demographics
NPI:1063458248
Name:HANLON, ANDRA M (ARNP)
Entity Type:Individual
Prefix:
First Name:ANDRA
Middle Name:M
Last Name:HANLON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:900 S PINE ISLAND RD
Mailing Address - Street 2:SUITE 800
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3920
Mailing Address - Country:US
Mailing Address - Phone:954-971-3210
Mailing Address - Fax:954-971-3427
Practice Address - Street 1:4570 LYONS RD
Practice Address - Street 2:#110
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-3481
Practice Address - Country:US
Practice Address - Phone:954-971-3210
Practice Address - Fax:954-971-3427
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9241562363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL307661000Medicaid