Provider Demographics
NPI:1427368208
Name:POLK, ANDREA MARIE (FNP)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:MARIE
Last Name:POLK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:MARIE
Other - Last Name:BRUGGEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:109 US HIGHWAY 66 E
Mailing Address - Street 2:
Mailing Address - City:TELL CITY
Mailing Address - State:IN
Mailing Address - Zip Code:47586-2755
Mailing Address - Country:US
Mailing Address - Phone:812-547-3447
Mailing Address - Fax:812-547-9543
Practice Address - Street 1:109 US HIGHWAY 66 E
Practice Address - Street 2:
Practice Address - City:TELL CITY
Practice Address - State:IN
Practice Address - Zip Code:47586-2755
Practice Address - Country:US
Practice Address - Phone:812-547-3447
Practice Address - Fax:812-547-9543
Is Sole Proprietor?:No
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INF0710391363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily