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General NPI Number Information
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NPI Number | 1578101226
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Entity Type | Individual
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Provider Name | LOGAN ANDREWS APRN, FNP-BC
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Gender | Male
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Dates
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Enumeration Date | 12/12/2019
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Last Update Date | 01/18/2022
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Provider Practice Location Address
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Address Line | 7280 SW SR 26
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City | TRENTON
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State | FL
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Zip | 32693
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Country | US
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Telephone | 352-463-1222
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Fax |
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Provider Business Mailing Address
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Address Line | 12 SE 942ND ST
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City | OLD TOWN
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State | FL
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Zip | 32680-4364
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Country | US
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Telephone | 352-283-3144
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Fax | 352-329-4313
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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 | 163WG0600X
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Taxonomy Name | Gerontology Registered Nurse
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License Number | RN9374509
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 163WR0400X
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Taxonomy Name | Rehabilitation Registered Nurse
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License Number | RN9374509
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 11007830
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License Number State | FL
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