Provider Demographics
NPI:1356121875
Name:GHEORGHE, ANDREI CRISTIAN
Entity type:Individual
Prefix:
First Name:ANDREI
Middle Name:CRISTIAN
Last Name:GHEORGHE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5412 MILLENIA LAKES BLVD APT 3215
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32839-3367
Mailing Address - Country:US
Mailing Address - Phone:239-691-5797
Mailing Address - Fax:
Practice Address - Street 1:5412 MILLENIA LAKES BLVD APT 3215
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32839-3367
Practice Address - Country:US
Practice Address - Phone:239-691-5797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9117932363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant