Provider Demographics
NPI:1134768476
Name:CHARLES, ANDREA JOANNA (FNP)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:JOANNA
Last Name:CHARLES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2248 BRECKENRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-5409
Mailing Address - Country:US
Mailing Address - Phone:504-621-5464
Mailing Address - Fax:
Practice Address - Street 1:101 W ROBERT E LEE BLVD
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70124-2459
Practice Address - Country:US
Practice Address - Phone:504-288-3456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-03
Last Update Date:2021-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA208858363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily