Provider Demographics
NPI:1073100368
Name:COHN, ANDREA SUE (RN)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:SUE
Last Name:COHN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4651 BABCOCK ST NE STE 18
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-2808
Mailing Address - Country:US
Mailing Address - Phone:305-965-7820
Mailing Address - Fax:
Practice Address - Street 1:1100 LUMINARY CIR UNIT 106
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-6672
Practice Address - Country:US
Practice Address - Phone:305-965-7820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2566502163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory CareGroup - Single Specialty