Provider Demographics
NPI:1033455100
Name:ROLDAN, ANDREA (CPNP)
Entity Type:Individual
Prefix:MISS
First Name:ANDREA
Middle Name:
Last Name:ROLDAN
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3230 I-30
Mailing Address - Street 2:STE. 100
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-2664
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3230 I-30
Practice Address - Street 2:STE. 100
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-2664
Practice Address - Country:US
Practice Address - Phone:972-682-1791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-18
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX817178363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics