Provider Demographics
NPI:1346748340
Name:GARLING, ANDREA MARIE (RN BSN)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:MARIE
Last Name:GARLING
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:MRS
Other - First Name:ANDREA
Other - Middle Name:MARIE
Other - Last Name:CUCITI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN BSN
Mailing Address - Street 1:143 NORTH PEARL STREET
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424
Mailing Address - Country:US
Mailing Address - Phone:585-396-3933
Mailing Address - Fax:585-396-3775
Practice Address - Street 1:143 NORTH PEARL STREET
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424
Practice Address - Country:US
Practice Address - Phone:585-396-3933
Practice Address - Fax:585-396-3775
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-25
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY413610163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01394389Medicaid