Andrea Distefano, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

9262502 Issued in FL

Practice address

103 Solana Rd
Suite B
Ponte Vedra Beach, FL 32082-2231

Phone

(904) 273-2717

Fax

(904) 273-0410

NPI assigned

May 16, 2014

Last updated

Oct 14, 2016By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in DE

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: andrea@beachesderm.emadirect.md

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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  • NPI 1962034918
  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1400198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1476403200000",
    "number": "1639580236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 SOLANA RD",
            "address_2": "SUITE B",
            "city": "PONTE VEDRA BEACH",
            "state": "FL",
            "postal_code": "320822231",
            "telephone_number": "904-273-2717",
            "fax_number": "904-273-0410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 SOLANA RD",
            "address_2": "SUITE B",
            "city": "PONTE VEDRA BEACH",
            "state": "FL",
            "postal_code": "320822231",
            "telephone_number": "904-273-2717",
            "fax_number": "904-273-0410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DISTEFANO",
        "first_name": "ANDREA",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-05-16",
        "last_updated": "2016-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "9262502",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FL ARNP LICENSE #",
            "identifier": "9262502",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Diagnostic Imaging PA
• Jorge Andres Diaz, M.D.
• Cheryl Anne Dietly
• Michaela Mayol Dimain, APRN
• Adam Dimitrov, MD
• Sarah Marie Dodds, OTR/L
• Emma Dorsett, PT, DPT
• Alisha Dionne Dowdy, CCC-SLP
• Carisa Nicole Doxzon, MS CCC-SLP
• Dr Fairall and Associates Behavioral Health and Family Mediation Servi

• Family Nurse Practitioner in Ponte Vedra Beach, FL
• Providers in Ponte Vedra Beach, FL by specialty
• Family Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.