Healthcare Provider Details

I. General information

NPI: 1215214382
Provider Name (Legal Business Name): ANDREW WILLIAM GEERS PA-C, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2011
Last Update Date: 02/22/2023
Certification Date: 02/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

596 OCOEE COMMERCE PKWY
OCOEE FL
34761-4219
US

IV. Provider business mailing address

13715 WATERHOUSE WAY
ORLANDO FL
32828-8349
US

V. Phone/Fax

Practice location:
  • Phone: 407-654-3505
  • Fax: 407-654-4956
Mailing address:
  • Phone: 813-789-4206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAL3193
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9109056
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: