Provider Demographics
NPI:1336835503
Name:ALEGRIA ROA, ANDREA CECILIA
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:CECILIA
Last Name:ALEGRIA ROA
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:PO BOX 947313
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30394-7313
Mailing Address - Country:US
Mailing Address - Phone:240-264-0759
Mailing Address - Fax:
Practice Address - Street 1:1061 MEDICAL CENTER DR STE 300
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8227
Practice Address - Country:US
Practice Address - Phone:386-917-7620
Practice Address - Fax:386-917-7621
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-12
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11022760363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily