Provider Demographics
NPI:1699024950
Name:WRIGHT, ANDREA K
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:K
Last Name:WRIGHT
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 1:2526 SW 31ST PL
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-2806
Mailing Address - Country:US
Mailing Address - Phone:352-575-0212
Mailing Address - Fax:
Practice Address - Street 1:901 NW 8TH AVE
Practice Address - Street 2:B2-2
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-5011
Practice Address - Country:US
Practice Address - Phone:352-575-0216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-02
Last Update Date:2012-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA63607174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist