Provider Demographics
NPI:1942407036
Name:GORJACZEW, ANDREA MICHELLE (DO)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:MICHELLE
Last Name:GORJACZEW
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:1018 MAGNOLIA WOODS CT
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-2289
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:820 PRUDENTIAL DR
Practice Address - Street 2:SUITE 713
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8210
Practice Address - Country:US
Practice Address - Phone:800-936-5996
Practice Address - Fax:904-346-0864
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2013-05-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLOS11252207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine