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General NPI Number Information
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NPI Number | 1396148326
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Entity Type | Individual
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Provider Name | JIMMY FLOYD ANDAZOLA PA-C
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Gender | Male
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Dates
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Enumeration Date | 10/05/2014
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Last Update Date | 12/11/2025
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Provider Practice Location Address
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Address Line | 10571 VISTA BELLA PL NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87114-3875
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Country | US
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Telephone | 505-259-1133
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Fax |
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Provider Business Mailing Address
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Address Line | 10571 VISTA BELLA PL NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87114-3875
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Country | US
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Telephone | 505-259-1133
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Fax |
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA2014-0051
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 4505
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 10494
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License Number State | GA
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA2014-0051
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License Number State | NM
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Taxonomy #5
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 3518
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License Number State | SC
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Taxonomy #6
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 7337
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License Number State | WI
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