Provider Demographics
NPI:1548233539
Name:BURGOYNE, ANDREA M (PA-C)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:M
Last Name:BURGOYNE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 AACHEN RD
Mailing Address - Street 2:
Mailing Address - City:SEASIDE
Mailing Address - State:CA
Mailing Address - Zip Code:93955-6400
Mailing Address - Country:US
Mailing Address - Phone:831-242-5594
Mailing Address - Fax:
Practice Address - Street 1:473 CABRILLO ST
Practice Address - Street 2:STE AIA
Practice Address - City:PRESIDIO OF MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93944-3201
Practice Address - Country:US
Practice Address - Phone:831-242-5594
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17914363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical