Provider Demographics
NPI:1245800416
Name:SKOKAN, ANDREW JAMES (FNP)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:JAMES
Last Name:SKOKAN
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13975 MONO WAY STE G
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-2824
Mailing Address - Country:US
Mailing Address - Phone:209-533-9600
Mailing Address - Fax:
Practice Address - Street 1:13975 MONO WAY
Practice Address - Street 2:SUITE G
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-2824
Practice Address - Country:US
Practice Address - Phone:209-533-9600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95017504363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily