Provider Demographics
NPI:1629440110
Name:WALTER, ANDREA B
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:B
Last Name:WALTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2699
Mailing Address - Street 2:ATTN: SHMG/HPE
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32513-2699
Mailing Address - Country:US
Mailing Address - Phone:850-416-7008
Mailing Address - Fax:850-416-7003
Practice Address - Street 1:1549 AIRPORT BLVD
Practice Address - Street 2:STE 310
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8633
Practice Address - Country:US
Practice Address - Phone:850-416-7008
Practice Address - Fax:850-416-7003
Is Sole Proprietor?:No
Enumeration Date:2015-10-23
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1234363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner