Provider Demographics
NPI:1487106068
Name:JARDINE, ANDREA (SURGICAL ASSISTANT)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:JARDINE
Suffix:
Gender:F
Credentials:SURGICAL ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 W RAY RD STE 1
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-3595
Mailing Address - Country:US
Mailing Address - Phone:480-814-9500
Mailing Address - Fax:480-814-9501
Practice Address - Street 1:2450 W RAY RD STE 1
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-3595
Practice Address - Country:US
Practice Address - Phone:480-814-9500
Practice Address - Fax:480-814-9501
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-28
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant