Provider Demographics
NPI:1578101226
Name:ANDREWS, LOGAN (APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:LOGAN
Middle Name:
Last Name:ANDREWS
Suffix:
Gender:M
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 SE 942ND ST
Mailing Address - Street 2:
Mailing Address - City:OLD TOWN
Mailing Address - State:FL
Mailing Address - Zip Code:32680-4364
Mailing Address - Country:US
Mailing Address - Phone:352-283-3144
Mailing Address - Fax:352-329-4313
Practice Address - Street 1:7280 SW SR 26
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:FL
Practice Address - Zip Code:32693
Practice Address - Country:US
Practice Address - Phone:352-463-1222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-12
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9374509163WG0600X, 163WR0400X
FL11007830363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0600XNursing Service ProvidersRegistered NurseGerontology
No163WR0400XNursing Service ProvidersRegistered NurseRehabilitation