Provider Demographics
NPI:1376986893
Name:MULLICAN, ANDREA DARLA (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:DARLA
Last Name:MULLICAN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 COUNTY ROAD 378
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:AL
Mailing Address - Zip Code:35673-5347
Mailing Address - Country:US
Mailing Address - Phone:256-303-3028
Mailing Address - Fax:
Practice Address - Street 1:236 COUNTY ROAD 378
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:AL
Practice Address - Zip Code:35673
Practice Address - Country:US
Practice Address - Phone:256-303-3028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-15
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-070097363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily