Provider Demographics
NPI:1669585873
Name:PENNANT, ANDRIA U (MD)
Entity type:Individual
Prefix:DR
First Name:ANDRIA
Middle Name:U
Last Name:PENNANT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:340 TOWN PLAZA AVE STE 240
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA
Mailing Address - State:FL
Mailing Address - Zip Code:32081-5169
Mailing Address - Country:US
Mailing Address - Phone:904-395-5850
Mailing Address - Fax:904-395-5851
Practice Address - Street 1:340 TOWN PLAZA AVE STE 240
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA
Practice Address - State:FL
Practice Address - Zip Code:32081-5169
Practice Address - Country:US
Practice Address - Phone:904-395-5850
Practice Address - Fax:904-395-5851
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08131300207V00000X
FLME155928207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology