Provider Demographics
NPI:1932370723
Name:WALBORN-HAYNIE, ANDREA SUSAN (ARNP)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:SUSAN
Last Name:WALBORN-HAYNIE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:SUSAN
Other - Last Name:WALBORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:1219 S EAST AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2356
Mailing Address - Country:US
Mailing Address - Phone:855-433-2010
Mailing Address - Fax:855-433-2010
Practice Address - Street 1:1219 S EAST AVE STE 301
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2356
Practice Address - Country:US
Practice Address - Phone:855-433-2010
Practice Address - Fax:855-433-2010
Is Sole Proprietor?:No
Enumeration Date:2008-03-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9443100364SM0705X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SM0705XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistMedical-Surgical