Provider Demographics
NPI:1699237404
Name:HIDALGO, ANDREA MARIE (NP)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:MARIE
Last Name:HIDALGO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:883 INVERNESS CT
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-7075
Mailing Address - Country:US
Mailing Address - Phone:925-550-4612
Mailing Address - Fax:
Practice Address - Street 1:4041 LONE TREE WAY
Practice Address - Street 2:STE 110
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531-6208
Practice Address - Country:US
Practice Address - Phone:925-757-2900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-01
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16159363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner