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General NPI Number Information
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NPI Number | 1992446207
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Entity Type | Individual
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Provider Name | ANDREW DESTRO
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Gender | Male
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Dates
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Enumeration Date | 04/02/2022
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Last Update Date | 11/16/2022
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Provider Practice Location Address
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Address Line | 2626 CAPITAL MEDICAL BLVD
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City | TALLAHASSEE
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State | FL
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Zip | 32308-4402
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Country | US
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Telephone | 850-325-5911
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Fax |
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Provider Business Mailing Address
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Address Line | 850 S GADSDEN ST UNIT 805
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City | TALLAHASSEE
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State | FL
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Zip | 32301-2443
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Country | US
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Telephone | 404-786-2440
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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 | 367H00000X
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Taxonomy Name | Anesthesiologist Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 367H00000X
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Taxonomy Name | Anesthesiologist Assistant
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License Number | AA793
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License Number State | FL
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