Provider Demographics
NPI:1134634249
Name:GRABOWSKI, ANDREA LEE (APRN)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:LEE
Last Name:GRABOWSKI
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MRS
Other - First Name:ANDREA
Other - Middle Name:LEE
Other - Last Name:MERCADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:2506 SUNSET DRIVE
Mailing Address - Street 2:
Mailing Address - City:NEW SMRYNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168
Mailing Address - Country:US
Mailing Address - Phone:386-281-0939
Mailing Address - Fax:386-944-9746
Practice Address - Street 1:1129 N DIXIE FREEWAY
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168
Practice Address - Country:US
Practice Address - Phone:386-281-0939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-12
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9426002363LF0000X
FLARNP9426002363LF0000X
FLAPRN9426002363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily