Provider Demographics
NPI:1982687471
Name:BREEDLOVE, ANDREA S (FNP)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:S
Last Name:BREEDLOVE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:S
Other - Last Name:BREEDLOVE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:GNP
Mailing Address - Street 1:149 PEBBLE BEACH DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72212-2621
Mailing Address - Country:US
Mailing Address - Phone:501-247-9819
Mailing Address - Fax:267-295-6086
Practice Address - Street 1:1 SAINT VINCENT CIR STE 350
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5408
Practice Address - Country:US
Practice Address - Phone:501-353-2328
Practice Address - Fax:267-295-6086
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA001719363LF0000X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5A962OtherARKANSAS BLUE CROSS BLUE SHIELD
AR5A923Medicare PIN
TXQ50630Medicare UPIN