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Andrea Moreno-Lackman

Nurse Practitioner

Physician Assistants & Advanced Practice Nursing Providers

4500 San Pablo Rd S, Jacksonville, FL 32224

(904) 953-2000

PECOS Enrollment

Based on the most recent information from CMS, provider Andrea Moreno-Lackman is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 8 days ago.

Profile Details

Provider ID
1689984106
Provider Type
Individual
Full Name
Moreno-Lackman, Andrea
Credential
ARNP

Gender
Female
Sole Proprietor
No
Enumeration Date
10/18/2010
Last Updated
10/5/2020

Contact Information

Practice Location

4500 San Pablo Rd S, Jacksonville, FL 32224

(904) 953-2000

Unlisted Fax

Mailing Location

4500 San Pablo Rd S, Jacksonville, FL 32224-1865

(904) 953-2000

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363L00000X Primary	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License ARNP9348867 Florida

Andrea Moreno-Lackman

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Dehr, Lindsay Mychael

Mattingly, Jessica

Molenaar, Michelle Lynn

Brown, Alethea Brooke

Fields, Pamela Dawn

Chang, Anna Y

Sheridan-Young, Jean

Remigaylo, Galina Aleksandrovna

Mazer, Laura S

Ahn, Ana Gabriela