Provider Demographics
NPI:1265753701
Name:PEPIN, ANDREA (MD)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:PEPIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:FL
Mailing Address - Zip Code:32693-3239
Mailing Address - Country:US
Mailing Address - Phone:352-463-6293
Mailing Address - Fax:
Practice Address - Street 1:911 S MAIN ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:FL
Practice Address - Zip Code:32693-3239
Practice Address - Country:US
Practice Address - Phone:352-463-6293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-18
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011033304208000000X
FLME 125037208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1265753701Medicaid