Provider Demographics
NPI:1689170045
Name:MCANDREW, JODI SULLIVAN (FNP-BC)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:SULLIVAN
Last Name:MCANDREW
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4253 E GEDDES AVE
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80122-2258
Mailing Address - Country:US
Mailing Address - Phone:603-771-1418
Mailing Address - Fax:
Practice Address - Street 1:7700 S BROADWAY
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80122-2602
Practice Address - Country:US
Practice Address - Phone:303-734-8619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-04
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0992191-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily