Provider Demographics
NPI:1710384540
Name:ANDRE, ROLANDA DESIR
Entity Type:Individual
Prefix:
First Name:ROLANDA
Middle Name:DESIR
Last Name:ANDRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ROLANDA
Other - Middle Name:
Other - Last Name:DESIR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP
Mailing Address - Street 1:7421 N UNIVERSITY DR STE 314
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-2952
Mailing Address - Country:US
Mailing Address - Phone:954-724-3440
Mailing Address - Fax:954-724-3494
Practice Address - Street 1:8900 N KENDALL DR
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2118
Practice Address - Country:US
Practice Address - Phone:305-271-6159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-21
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9358264363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1710384540Medicaid