Healthcare Provider Details

I. General information

NPI: 1174468615
Provider Name (Legal Business Name): GORDON SAMUEL ANDREWS JR. APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 DON WICKHAM DR
CLERMONT FL
34711-1979
US

IV. Provider business mailing address

2261 CYPRESS CREEK ST
AUBURNDALE FL
33823-2268
US

V. Phone/Fax

Practice location:
  • Phone: 352-394-4071
  • Fax:
Mailing address:
  • Phone: 228-219-3229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number11048282
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN9710474
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: