Individual provider Active NPI

Andell Y Phillip

  • Homemaker
  • Lake Mary, FL
National Provider Identifier
1922563030
Registry record updated Dec 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
HomemakerTaxonomy code 376J00000X
License
239577 Issued in FL
Practice address
1540 International Pkwy Ste 2000
Lake Mary, FL 32746-5096
Phone
(352) 502-4923
Fax
(352) 504-0241
NPI assigned
Feb 2, 2019
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 1, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse's Aide 376K00000X 166697 FL
Homemaker 376J00000X 239577 FL Primary

Addresses

Primary practice location

1540 International Pkwy Ste 2000
Lake Mary, FL 32746-5096

Mailing address

8810 SW Highway 200 Unit 124
Ocala, FL 34481-7822
Phone (352) 502-4923

Other practice location 1

7402 N 56th St Ste 100H
Tampa, FL 33617-7746
Phone (813) 733-7497

Other practice location 2

8810 SW Highway 200 Unit 124
Ocala, FL 34481-7822
Phone (352) 502-4923

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
239577FLMDHomemaker
166697FLMDNurse's Aide

Practice roles

OrganizationSpecialtyStatusNew patients
Ourlove Senior Care Inc. CurrentSince May 1, 2023 Accepting new patients
Amlove Senior Care Inc CurrentSince Apr 17, 2020 Accepting new patients

Locations

1540 International Pkwy
Ste 2000
Lake Mary, FL 32746
Phone (407) 287-9179

8810 SW Highway 200
Unit 124
Ocala, FL 34481
Phone (352) 502-4923

7402 N 56th St
Ste 100H
Tampa, FL 33617
Phone (813) 733-4977

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1549065600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701388800000",
    "number": "1922563030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8810 SW HIGHWAY 200 UNIT 124",
            "city": "OCALA",
            "state": "FL",
            "postal_code": "344817822",
            "telephone_number": "352-502-4923"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1540 INTERNATIONAL PKWY STE 2000",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327465096",
            "telephone_number": "352-502-4923",
            "fax_number": "352-504-0241"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7402 N 56th St Ste 100H",
            "address_purpose": "LOCATION",
            "city": "Tampa",
            "state": "FL",
            "postal_code": "336177746",
            "country_code": "US",
            "telephone_number": "813-733-7497",
            "fax_number": "352-504-0241",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8810 SW Highway 200 Unit 124",
            "address_purpose": "LOCATION",
            "city": "Ocala",
            "state": "FL",
            "postal_code": "344817822",
            "country_code": "US",
            "telephone_number": "352-502-4923",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PHILLIP",
        "first_name": "ANDELL",
        "middle_name": "Y",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-02-02",
        "last_updated": "2023-12-01",
        "certification_date": "2023-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "376K00000X",
            "taxonomy_group": "",
            "desc": "Nurse's Aide",
            "state": "FL",
            "license": "166697",
            "primary": false
        },
        {
            "code": "376J00000X",
            "taxonomy_group": "",
            "desc": "Homemaker",
            "state": "FL",
            "license": "239577",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Mary, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.