Provider Demographics
NPI:1225710833
Name:COOK, ANDREA PATREECE (APRN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:PATREECE
Last Name:COOK
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21300 BEACH BLVD APT S211
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-5778
Mailing Address - Country:US
Mailing Address - Phone:916-753-7813
Mailing Address - Fax:
Practice Address - Street 1:21300 BEACH BLVD APT S211
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-5778
Practice Address - Country:US
Practice Address - Phone:916-753-7813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-02
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ295300363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health