Provider Demographics
NPI:1063827855
Name:THAYER, ANDREA ETHEL (MSN, APRN)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:ETHEL
Last Name:THAYER
Suffix:
Gender:F
Credentials:MSN, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13704 VILLAGE LAKEVIEW AVE.
Mailing Address - Street 2:SUITE# 250
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786
Mailing Address - Country:US
Mailing Address - Phone:407-408-7931
Mailing Address - Fax:407-393-5526
Practice Address - Street 1:13704 VILLAGE LAKEVIEW AVE.
Practice Address - Street 2:SUITE #250
Practice Address - City:WINDERMERE
Practice Address - State:FL
Practice Address - Zip Code:34786
Practice Address - Country:US
Practice Address - Phone:407-408-7931
Practice Address - Fax:407-393-5526
Is Sole Proprietor?:No
Enumeration Date:2014-06-30
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13-94770-092163W00000X
KS53-77278-092363LP0200X
FL9495387363LP0200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics