Provider Demographics
NPI:1023577483
Name:FERNANDEZ, ANDREA (NP)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:GARZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1401 E RIDGE RD STE C
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-1525
Mailing Address - Country:US
Mailing Address - Phone:956-317-4243
Mailing Address - Fax:956-800-4275
Practice Address - Street 1:1401 E RIDGE RD STE C
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1525
Practice Address - Country:US
Practice Address - Phone:956-317-4243
Practice Address - Fax:956-800-4275
Is Sole Proprietor?:No
Enumeration Date:2019-03-15
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139793363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8KW481OtherBCBXTX
TX397081601OtherMEDICAID LINKED TO J RICARDO SOBREVILLA MD PLLC
TX795177OtherMEDICARE LINKED TO J RICARDO SOBREVILLA MD PLLC
TXP02250072OtherRR MEDICARE