Provider Demographics
NPI:1194384529
Name:GLEASON, ANDREW J (RN)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:J
Last Name:GLEASON
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 PEAK CIR
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32738-6829
Mailing Address - Country:US
Mailing Address - Phone:407-927-3116
Mailing Address - Fax:
Practice Address - Street 1:1111 PEAK CIR
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32738-6829
Practice Address - Country:US
Practice Address - Phone:407-927-3116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9308555163WN0800X, 163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No163WN0800XNursing Service ProvidersRegistered NurseNeuroscience