Provider Demographics
NPI:1396007993
Name:GREEN, ANDREW DAVID (ARNP)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:DAVID
Last Name:GREEN
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2023 MYRA ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-3714
Mailing Address - Country:US
Mailing Address - Phone:904-503-5464
Mailing Address - Fax:904-575-4399
Practice Address - Street 1:2023 MYRA ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-3714
Practice Address - Country:US
Practice Address - Phone:904-503-5464
Practice Address - Fax:904-575-4399
Is Sole Proprietor?:No
Enumeration Date:2012-06-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9176315363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily