Healthcare Provider Details

I. General information

NPI: 1164824546
Provider Name (Legal Business Name): ANDREW DAVID WHITE PA-S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2014
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13770 PLANTATION RD # 103
FORT MYERS FL
33912-4460
US

IV. Provider business mailing address

4815 FRATTINA ST
AVE MARIA FL
34142-5121
US

V. Phone/Fax

Practice location:
  • Phone: 941-444-0011
  • Fax: 603-952-3900
Mailing address:
  • Phone: 971-275-3741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA173943
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9120283
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: