Provider Demographics
NPI:1356514343
Name:PARROTT, ANDREA TIFFANY (CNP)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:TIFFANY
Last Name:PARROTT
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:885 ROOSEVELT RD STE 101
Mailing Address - Street 2:
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-6141
Mailing Address - Country:US
Mailing Address - Phone:630-384-6200
Mailing Address - Fax:
Practice Address - Street 1:885 ROOSEVELT RD STE 101
Practice Address - Street 2:
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-6141
Practice Address - Country:US
Practice Address - Phone:630-384-6200
Practice Address - Fax:630-384-6229
Is Sole Proprietor?:No
Enumeration Date:2008-04-10
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.007052363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL$$$$$$$$$001Medicaid
ILIL5966003Medicare PIN
ILIL5966Medicare PIN