Provider Demographics
NPI:1295701043
Name:ANDREA, KATHLEEN A (FNP)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:A
Last Name:ANDREA
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 1:82 S STONE AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85701-1713
Mailing Address - Country:US
Mailing Address - Phone:520-792-3293
Mailing Address - Fax:520-792-4336
Practice Address - Street 1:2435 N CASTRO AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-5060
Practice Address - Country:US
Practice Address - Phone:520-622-8030
Practice Address - Fax:520-622-8012
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN103711363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ619497Medicaid
AZQ00942Medicare UPIN
AZ106280Medicare ID - Type Unspecified