Provider Demographics
NPI:1114799434
Name:MIN, ANDREANA SARA
Entity type:Individual
Prefix:
First Name:ANDREANA
Middle Name:SARA
Last Name:MIN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13999 GOLDMARK DR STE 282-C
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-4234
Mailing Address - Country:US
Mailing Address - Phone:469-248-5690
Mailing Address - Fax:
Practice Address - Street 1:9901 VALLEY RANCH PKWY E
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-4730
Practice Address - Country:US
Practice Address - Phone:972-417-1936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-30
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1140704363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily