Provider Demographics
NPI:1598473159
Name:VAUGHN, ANDREA RENEE (DOULA, CHW)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:RENEE
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:DOULA, CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28726 THOMASVILLE PL
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33545-4344
Mailing Address - Country:US
Mailing Address - Phone:541-647-3803
Mailing Address - Fax:
Practice Address - Street 1:923 S FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-1115
Practice Address - Country:US
Practice Address - Phone:863-683-4663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-11
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA14114374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty