Healthcare Provider Details

I. General information

NPI: 1548862998
Provider Name (Legal Business Name): TANIQUA DENISE ANDREWS NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2020
Last Update Date: 05/18/2022
Certification Date: 05/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3740 CURTIS BLVD STE 108
PORT ST JOHN FL
32927-3962
US

IV. Provider business mailing address

3740 CURTIS BLVD STE 108
PORT ST JOHN FL
32927-3962
US

V. Phone/Fax

Practice location:
  • Phone: 321-633-5500
  • Fax: 321-633-5566
Mailing address:
  • Phone: 321-633-5500
  • Fax: 321-633-5566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11010293
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: