=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629440110
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANDREA B. WALTER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/23/2015
-----------------------------------------------------
Last Update Date | 10/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1549 AIRPORT BLVD STE 310
-----------------------------------------------------
City | PENSACOLA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32504-8633
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-416-7008
-----------------------------------------------------
Fax | 850-416-7003
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4900 IVEY RD NW STE 1801
-----------------------------------------------------
City | ACWORTH
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30101-4001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-416-7008
-----------------------------------------------------
Fax | 850-416-7003
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | 334341
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | 9296278
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------