Provider Demographics
NPI:1326710856
Name:D'ANDREA, LARACEL (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:LARACEL
Middle Name:
Last Name:D'ANDREA
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:734 IRMA AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-3853
Mailing Address - Country:US
Mailing Address - Phone:407-305-3389
Mailing Address - Fax:917-477-6852
Practice Address - Street 1:734 IRMA AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-3853
Practice Address - Country:US
Practice Address - Phone:407-305-3389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-03
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY51369363LP0808X
FL11024124363LP0808X
TN34591363LP0808X
TX1113823363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health