Provider Demographics
NPI:1508290966
Name:WHIDDON, ANDREA L (NP-C)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:L
Last Name:WHIDDON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 W FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:SYLVESTER
Mailing Address - State:GA
Mailing Address - Zip Code:31791-1978
Mailing Address - Country:US
Mailing Address - Phone:229-776-2965
Mailing Address - Fax:229-776-4452
Practice Address - Street 1:1014 W FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:SYLVESTER
Practice Address - State:GA
Practice Address - Zip Code:31791-1978
Practice Address - Country:US
Practice Address - Phone:229-776-2965
Practice Address - Fax:229-776-4452
Is Sole Proprietor?:No
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN171380363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner