Healthcare Provider Details

I. General information

NPI: 1679193825
Provider Name (Legal Business Name): ANDREA LINDSEY MCCOLLUM PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2020
Last Update Date: 05/29/2020
Certification Date: 05/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

1600 SW ARCHER RD BOX 1001008
GAINESVILLE FL
32653
US

V. Phone/Fax

Practice location:
  • Phone: 912-399-9227
  • Fax:
Mailing address:
  • Phone: 352-273-5670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9113189
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: