Provider Demographics
NPI:1588003842
Name:ABBOTT, ANDREA SUSANNE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:SUSANNE
Last Name:ABBOTT
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:178 SCHOOLS DR
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:TN
Mailing Address - Zip Code:38320-3026
Mailing Address - Country:US
Mailing Address - Phone:731-584-3181
Mailing Address - Fax:731-584-2345
Practice Address - Street 1:100 CHESTERFIELD BUSINESS PKWY FL 2
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63005-1271
Practice Address - Country:US
Practice Address - Phone:831-218-6882
Practice Address - Fax:731-584-2345
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-20
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN17728363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily