Provider Demographics
NPI:1346971629
Name:ANDREA, MIKAYLA DANAE (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:MIKAYLA
Middle Name:DANAE
Last Name:ANDREA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5726 N 10TH ST UNIT 8
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-2273
Mailing Address - Country:US
Mailing Address - Phone:602-920-7850
Mailing Address - Fax:
Practice Address - Street 1:1008 E MCDOWELL RD STE A
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2603
Practice Address - Country:US
Practice Address - Phone:602-358-8588
Practice Address - Fax:602-688-6991
Is Sole Proprietor?:No
Enumeration Date:2022-06-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZF05220430363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care