Provider Demographics
NPI:1588990386
Name:SMITH, ANDREA G (NP)
Entity type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:G
Last Name:SMITH
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:1651 RUBY TYLER PKWY
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35404-2990
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1651 RUBY TYLER PKWY
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35404-2990
Practice Address - Country:US
Practice Address - Phone:205-507-8000
Practice Address - Fax:205-507-8501
Is Sole Proprietor?:No
Enumeration Date:2009-10-29
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL1-095819363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL115703Medicaid
AL1588990386Medicare PIN