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Provider Information for 1487969101

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

ANDREA L KICHLINE ARNP

Gender: FEMALE

Individual NPI: 1487969101

Calendar   Last Updated:  2020-03-03
  Certification Date:  2020-03-03

Details

Name Value
NPI 1487969101
Enumeration Date 2010-08-18
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 270 MAIN ST N STE 300
STILLWATER, MN 55082-6788
United States

Phone: 651-342-1039 | Fax: 651-342-1428
View Map External Link
Primary Practice Address 10150 HIGHLAND MANOR DR STE 240
TAMPA, FL 33610
United States

Phone: 813-259-1013 | Fax:
View Map External Link
Secondary Practice Address 985 SR 436
CASSELBERRY, FL 32707
United States

Phone: 407-831-5252 | Fax:
View Map External Link

985 SR 436
CASSELBERRY, FL 32707
United States

Phone: 407-831-5252 | Fax:
View Map External Link

Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Other RAILROAD MEDICARE FL P00960447
MEDICAID FL 008895500
Other LICENSE NUMBER FL ARNP9224467
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 363LA2200X - Nurse Practitioner Adult Health FL ARNP9224467