Provider Demographics
NPI:1063827855
Name:THAYER, ANDREA ETHEL (CPNP-PC)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:ETHEL
Last Name:THAYER
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 LOOKOUT PL
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-4491
Mailing Address - Country:US
Mailing Address - Phone:407-215-0400
Mailing Address - Fax:407-215-0402
Practice Address - Street 1:210 LOOKOUT PL
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4491
Practice Address - Country:US
Practice Address - Phone:407-215-0400
Practice Address - Fax:407-215-0402
Is Sole Proprietor?:No
Enumeration Date:2014-06-30
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13-94770-092163W00000X
KS53-77278-092363LP0200X
FL9495387363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse