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General NPI Number Information
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NPI Number | 1922643600
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Entity Type | Individual
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Provider Name | ANDREW WHITIS PA-C
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Gender | Male
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Dates
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Enumeration Date | 11/17/2019
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Last Update Date | 11/17/2019
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Provider Practice Location Address
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Address Line | 11382 PROSPERITY FARMS RD STE 228
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33410-3463
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Country | US
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Telephone | 561-253-3980
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Fax |
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Provider Business Mailing Address
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Address Line | 1617 SE NORTH BLACKWELL DR
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34952-6651
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Country | US
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Telephone | 334-507-0649
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 9112746
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License Number State | FL
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