Provider Demographics
NPI:1942616321
Name:ANDERSON, ANDREA CAPRICE (F-NPC)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:CAPRICE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:F-NPC
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:C
Other - Last Name:PRUITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:59185 POSTELL AVE
Mailing Address - Street 2:
Mailing Address - City:PLAQUEMINE
Mailing Address - State:LA
Mailing Address - Zip Code:70764-3462
Mailing Address - Country:US
Mailing Address - Phone:225-284-7158
Mailing Address - Fax:
Practice Address - Street 1:59185 POSTELL AVE
Practice Address - Street 2:
Practice Address - City:PLAQUEMINE
Practice Address - State:LA
Practice Address - Zip Code:70764-3462
Practice Address - Country:US
Practice Address - Phone:225-284-7158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-07
Last Update Date:2018-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07921363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily