Provider Demographics
NPI:1194172361
Name:PRIBAC, ANDREA (ANCP-BC)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:PRIBAC
Suffix:
Gender:F
Credentials:ANCP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2151 N HARBOR BLVD
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-3820
Mailing Address - Country:US
Mailing Address - Phone:714-446-5830
Mailing Address - Fax:
Practice Address - Street 1:2151 N HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3820
Practice Address - Country:US
Practice Address - Phone:714-446-5830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-18
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95004299363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care