Healthcare Provider Details

I. General information

NPI: 1295767143
Provider Name (Legal Business Name): ANDREA R KUIPER P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANDREA SENSECQUA P.A.

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 03/29/2021
Certification Date: 03/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8960 COLONIAL CENTER DR STE 302
FORT MYERS FL
33905-7810
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-343-9700
  • Fax: 239-343-9699
Mailing address:
  • Phone: 239-343-9700
  • Fax: 239-343-9699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9103589
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: