Provider Demographics
NPI:1639324452
Name:ASCENCIO-EVIA, ANDREA (MGC, CGC)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:ASCENCIO-EVIA
Suffix:
Gender:F
Credentials:MGC, CGC
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:SHORT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:360 CENTRAL AVE STE 1230
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-3865
Mailing Address - Country:US
Mailing Address - Phone:800-975-4819
Mailing Address - Fax:
Practice Address - Street 1:360 CENTRAL AVE STE 1230
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-3865
Practice Address - Country:US
Practice Address - Phone:800-975-4819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-20
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS