Provider Demographics
NPI:1245259951
Name:LAGNESE, ANDREA LYNNE (DC)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:LYNNE
Last Name:LAGNESE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14156 HAMPTON FALLS DR N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-3859
Mailing Address - Country:US
Mailing Address - Phone:904-699-5432
Mailing Address - Fax:
Practice Address - Street 1:135 PROFESSIONAL DR STE 105
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-7228
Practice Address - Country:US
Practice Address - Phone:904-280-1101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR006490111N00000X
FLCH8112111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor