Healthcare Provider Details

I. General information

NPI: 1568327104
Provider Name (Legal Business Name): ANDREW PALMER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

704 HEMLOCK LN
LAKELAND FL
33810-2882
US

IV. Provider business mailing address

704 HEMLOCK LN
LAKELAND FL
33810-2882
US

V. Phone/Fax

Practice location:
  • Phone: 813-857-0656
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN9494407
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: