Provider Demographics
NPI:1356866834
Name:TENNANCOUR, ANDREA ELAINE (NP)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:ELAINE
Last Name:TENNANCOUR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1531 WATERFORD DR
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-3818
Mailing Address - Country:US
Mailing Address - Phone:317-833-0585
Mailing Address - Fax:
Practice Address - Street 1:14350 MUNDY DR
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-7223
Practice Address - Country:US
Practice Address - Phone:317-922-0909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-07
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71007209A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health