Provider Demographics
NPI:1225709868
Name:RENZI, ANDREW STEVEN (CRNP)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:STEVEN
Last Name:RENZI
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 WOLF ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19148-2911
Mailing Address - Country:US
Mailing Address - Phone:267-446-3416
Mailing Address - Fax:
Practice Address - Street 1:1315 WOLF ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19148-2911
Practice Address - Country:US
Practice Address - Phone:267-773-7311
Practice Address - Fax:267-773-7312
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-23
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP024395363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily