Provider Demographics
NPI:1295821387
Name:MARION, ANDREA LYNN
Entity type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:LYNN
Last Name:MARION
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2514 LINDA AVE
Mailing Address - Street 2:REAR APT
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-5114
Mailing Address - Country:US
Mailing Address - Phone:305-731-9218
Mailing Address - Fax:866-903-4377
Practice Address - Street 1:17615 SW 97TH AVE
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-5636
Practice Address - Country:US
Practice Address - Phone:786-268-2611
Practice Address - Fax:786-268-1748
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL811931700Medicaid
FL766660800Medicaid