Provider Demographics
NPI:1295767143
Name:KUIPER, ANDREA R (PA)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:R
Last Name:KUIPER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:SENSECQUA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-343-9700
Mailing Address - Fax:239-343-9699
Practice Address - Street 1:8960 COLONIAL CENTER DR STE 302
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33905-7810
Practice Address - Country:US
Practice Address - Phone:239-343-9700
Practice Address - Fax:239-343-9699
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AS0400X
FLPA9103589363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000621200Medicaid
FLP01272555OtherRAILROAD MCR
FLY04JJOtherBCBS OF FL
FLS81615Medicare UPIN
FL000621200Medicaid