Healthcare Provider Details

I. General information

NPI: 1588201875
Provider Name (Legal Business Name): ANDREA LYNN HUSEN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2019
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 HOSPITAL DR STE 125
PALM COAST FL
32164-2455
US

IV. Provider business mailing address

17602 WRIGHT ST STE 105
OMAHA NE
68130-2097
US

V. Phone/Fax

Practice location:
  • Phone: 386-586-1705
  • Fax: 386-586-1706
Mailing address:
  • Phone: 402-614-9700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11042639
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: