Provider Demographics
NPI:1699030924
Name:CAINES, ANDREA JENISE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:JENISE
Last Name:CAINES
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 9TH STREET DR W
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-4802
Mailing Address - Country:US
Mailing Address - Phone:941-721-3900
Mailing Address - Fax:
Practice Address - Street 1:218 9TH STREET DR W
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:FL
Practice Address - Zip Code:34221-4802
Practice Address - Country:US
Practice Address - Phone:941-721-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-12
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9241073363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006511500Medicaid