Provider Demographics
NPI:1841364577
Name:PRINCE, ANDREA M (M D)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:M
Last Name:PRINCE
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8409 SW 80TH ST STE 8
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34481-9117
Mailing Address - Country:US
Mailing Address - Phone:352-414-1922
Mailing Address - Fax:844-388-6186
Practice Address - Street 1:8409 SW 80TH ST STE 8
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34481-9117
Practice Address - Country:US
Practice Address - Phone:352-414-1922
Practice Address - Fax:844-388-6186
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME150481207Q00000X
MS14807207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00125447Medicaid
MS080003644Medicare ID - Type Unspecified
MS00125447Medicaid