Provider Demographics
NPI:1871014043
Name:ANDREA GOLD
Entity Type:Organization
Organization Name:ANDREA GOLD
Other - Org Name:ADVANCED SURGICAL AND WOUND CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:WOUND CARE SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:GOLD
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:303-907-3426
Mailing Address - Street 1:2132 KERRY HILL DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-5762
Mailing Address - Country:US
Mailing Address - Phone:303-907-3426
Mailing Address - Fax:
Practice Address - Street 1:222 N SEPULVEDA BLVD
Practice Address - Street 2:
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-5648
Practice Address - Country:US
Practice Address - Phone:188-893-0333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-28
Last Update Date:2017-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0993143-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO=========OtherMEDICARE
CO=========Medicaid