Provider Demographics
NPI:1578028619
Name:MATHURIN, ANDIE
Entity Type:Individual
Prefix:
First Name:ANDIE
Middle Name:
Last Name:MATHURIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 LAKE LORINE DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32808-6122
Mailing Address - Country:US
Mailing Address - Phone:438-764-7975
Mailing Address - Fax:
Practice Address - Street 1:1717 LAKE LORINE DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808-6122
Practice Address - Country:US
Practice Address - Phone:438-764-7975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-03
Last Update Date:2019-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker