Provider Demographics
NPI:1841075843
Name:AMPUDIA, ANDRE ALFREDO (PA)
Entity type:Individual
Prefix:
First Name:ANDRE
Middle Name:ALFREDO
Last Name:AMPUDIA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5333 N DIXIE HWY STE 110
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33334-3453
Mailing Address - Country:US
Mailing Address - Phone:954-772-8554
Mailing Address - Fax:954-772-9662
Practice Address - Street 1:5333 N DIXIE HWY STE 110
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33334-3453
Practice Address - Country:US
Practice Address - Phone:352-796-7171
Practice Address - Fax:352-556-4889
Is Sole Proprietor?:No
Enumeration Date:2023-08-28
Last Update Date:2024-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9117771363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant