Provider Demographics
NPI:1295395952
Name:ANDREWS, JERRY (FNP, AG-ACNP)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:
Last Name:ANDREWS
Suffix:
Gender:M
Credentials:FNP, AG-ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:627 MAY APPLE WAY
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293-7278
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:209 PALERMO PL
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-2821
Practice Address - Country:US
Practice Address - Phone:941-488-1906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-15
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11003067363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Multi-Specialty