Provider Demographics
NPI:1639772064
Name:HATCHER, ANDREA NICHOLE (CRNA)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:NICHOLE
Last Name:HATCHER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4051 ROSCREA DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32309-2227
Mailing Address - Country:US
Mailing Address - Phone:850-728-8197
Mailing Address - Fax:
Practice Address - Street 1:2701 S BLAIRSTONE RD
Practice Address - Street 2:SUITE GC3
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301
Practice Address - Country:US
Practice Address - Phone:850-728-8197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11010861367500000X
FL9324407163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse