Provider Demographics
NPI:1811734437
Name:ANDRADE, MARIJA DAVIS (APRN, FNP)
Entity type:Individual
Prefix:
First Name:MARIJA
Middle Name:DAVIS
Last Name:ANDRADE
Suffix:
Gender:F
Credentials:APRN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13749 FM 1826
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78737-9159
Mailing Address - Country:US
Mailing Address - Phone:512-560-5591
Mailing Address - Fax:512-623-5399
Practice Address - Street 1:4316 JAMES CASEY ST # A-200
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1116
Practice Address - Country:US
Practice Address - Phone:512-623-5300
Practice Address - Fax:512-623-5399
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1168696363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty