Provider Demographics
NPI:1952704975
Name:SUMNER, ANDREA MICHELLE (PA)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:MICHELLE
Last Name:SUMNER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:121 TERRY AVE
Mailing Address - Street 2:
Mailing Address - City:HURLBURT FIELD
Mailing Address - State:FL
Mailing Address - Zip Code:32544-5213
Mailing Address - Country:US
Mailing Address - Phone:805-884-2597
Mailing Address - Fax:
Practice Address - Street 1:121 TERRY AVE
Practice Address - Street 2:
Practice Address - City:HURLBURT FIELD
Practice Address - State:FL
Practice Address - Zip Code:32544-5213
Practice Address - Country:US
Practice Address - Phone:850-884-2597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-04
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant