Provider Demographics
NPI:1881301299
Name:CAINE, ANDREA M
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:M
Last Name:CAINE
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 1:1580 DRAYTON AVE
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-5671
Mailing Address - Country:US
Mailing Address - Phone:386-748-3558
Mailing Address - Fax:
Practice Address - Street 1:1580 DRAYTON AVE
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-5671
Practice Address - Country:US
Practice Address - Phone:386-748-3558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-04
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility