MEDICARE: ANDREA ELAINE SHORT FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	APRN11044757	FL

General Provider Information

NPI Number	:	1568320323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA ELAINE SHORT FNP-C

Provider Business Mailing Address
First Line	:	5655 OCARINA RD
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34291-2208
Country	:	US
Telephone Number	:	239-233-7949
Fax Number	:

Provider Business Practice Location Address
First Line	:	2721 DEL PRADO BLVD S STE 100
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33904-5782
Country	:	US
Telephone Number	:	239-242-8010
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2026
Last Update Date	:	01/12/2026

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