Provider Demographics
NPI:1467024455
Name:PLACE, ANDREA (FNP-C)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:PLACE
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Gender:F
Credentials:FNP-C
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Other - Last Name:
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Mailing Address - Street 1:6920 POINTE INVERNESS WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-7934
Mailing Address - Country:US
Mailing Address - Phone:260-434-6403
Mailing Address - Fax:260-434-6395
Practice Address - Street 1:7916 W JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-4140
Practice Address - Country:US
Practice Address - Phone:260-434-6412
Practice Address - Fax:260-434-6395
Is Sole Proprietor?:No
Enumeration Date:2021-07-11
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN28229563A207Q00000X, 363LF0000X
IN71011572363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine