Provider Demographics
NPI:1386831261
Name:AQUADRO, ANDREA (PA)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:AQUADRO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:AQUADRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:204 ANA DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-1750
Mailing Address - Country:US
Mailing Address - Phone:256-767-5940
Mailing Address - Fax:256-767-5943
Practice Address - Street 1:204 ANA DR STE B
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-1750
Practice Address - Country:US
Practice Address - Phone:256-767-5940
Practice Address - Fax:256-767-5943
Is Sole Proprietor?:No
Enumeration Date:2007-09-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA553363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051545350OtherBLUE CROSS BLUE SHIELD
AL051545350OtherBLUE CROSS BLUE SHIELD