Provider Demographics
NPI:1720141294
Name:HERINGTON, ANDREA LEA (FNP)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:LEA
Last Name:HERINGTON
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 1:530 VALLEY FORGE WAY
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-0546
Mailing Address - Country:US
Mailing Address - Phone:408-718-3693
Mailing Address - Fax:415-641-6996
Practice Address - Street 1:1580 VALENCIA ST STE 506
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-4418
Practice Address - Country:US
Practice Address - Phone:415-641-6996
Practice Address - Fax:415-641-6831
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10890363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB128762Medicare UPIN