Provider Demographics
NPI:1174686190
Name:TOBIASZ, ANDREA T (NP)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:T
Last Name:TOBIASZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15970 LOTTIE LN
Mailing Address - Street 2:
Mailing Address - City:WRIGHT CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63390-2230
Mailing Address - Country:US
Mailing Address - Phone:636-745-0001
Mailing Address - Fax:
Practice Address - Street 1:11501 PAGE SERVICE DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146-3530
Practice Address - Country:US
Practice Address - Phone:314-993-3014
Practice Address - Fax:314-993-7031
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MORN 097745363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health