Provider Demographics
NPI:1114007044
Name:DELOACH, ANDREA M (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:M
Last Name:DELOACH
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 KNIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-1943
Mailing Address - Country:US
Mailing Address - Phone:912-283-9423
Mailing Address - Fax:912-283-2946
Practice Address - Street 1:711 KNIGHT AVE
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-1943
Practice Address - Country:US
Practice Address - Phone:912-283-9423
Practice Address - Fax:912-283-2946
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN072616363LF0000X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00560381BMedicaid
GA1114007044OtherMEDICARE NPI
GACG6045OtherRAILROAD MEDICARE GROUP ID
GA20250I1380Medicare PIN