Provider Demographics
NPI:1962665638
Name:ANDRE, JAMIE (MD)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:ANDRE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 HARTMAN RD
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34947-4408
Mailing Address - Country:US
Mailing Address - Phone:772-465-1170
Mailing Address - Fax:772-465-1175
Practice Address - Street 1:2000 HARTMAN RD
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34947-4408
Practice Address - Country:US
Practice Address - Phone:772-465-1170
Practice Address - Fax:772-465-1175
Is Sole Proprietor?:No
Enumeration Date:2008-07-03
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251189207R00000X, 207RN0300X
NJ25MA09228600207R00000X, 207RN0300X
TN53493207R00000X
FLME110090207R00000X, 207RN0300X
FLME127673207R00000X, 207RN0300X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist