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General NPI Number Information
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NPI Number | 1063827855
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Entity Type | Individual
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Provider Name | ANDREA ETHEL THAYER MSN, APRN
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Gender | Female
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Dates
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Enumeration Date | 06/30/2014
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Last Update Date | 06/06/2024
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Provider Practice Location Address
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Address Line | 13704 VILLAGE LAKEVIEW AVE. SUITE #250
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City | WINDERMERE
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State | FL
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Zip | 34786
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Country | US
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Telephone | 407-408-7931
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Fax | 407-393-5526
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Provider Business Mailing Address
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Address Line | 13704 VILLAGE LAKEVIEW AVE. SUITE# 250
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City | WINDERMERE
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State | FL
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Zip | 34786
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Country | US
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Telephone | 407-408-7931
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Fax | 407-393-5526
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 13-94770-092
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 53-77278-092
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License Number State | KS
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Taxonomy #3
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 9495387
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 9495387
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License Number State | FL
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