Provider Demographics
NPI:1083831861
Name:WATERHOUSE, ANDREA E (ARNP)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:E
Last Name:WATERHOUSE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 100371
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0371
Mailing Address - Country:US
Mailing Address - Phone:352-338-2195
Mailing Address - Fax:352-265-0627
Practice Address - Street 1:395 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LAKE BUTLER
Practice Address - State:FL
Practice Address - Zip Code:32054-1642
Practice Address - Country:US
Practice Address - Phone:386-496-3154
Practice Address - Fax:386-496-1246
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1267412363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily