Provider Demographics
NPI:1407159429
Name:ANDREWS, JENNY OLETA (PA)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:OLETA
Last Name:ANDREWS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 S STRATFORD AVE STE B
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-5908
Mailing Address - Country:US
Mailing Address - Phone:805-332-8446
Mailing Address - Fax:805-332-8173
Practice Address - Street 1:316 S STRATFORD AVE STE B
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-5908
Practice Address - Country:US
Practice Address - Phone:805-332-8446
Practice Address - Fax:805-332-8173
Is Sole Proprietor?:No
Enumeration Date:2010-12-14
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPA721363A00000X
COPA3769363A00000X
CA56754363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant