MEDICARE: TINA ANDREWS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	F07170275	MO

General Provider Information

NPI Number	:	1528580479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TINA ANDREWS

Provider Business Mailing Address
First Line	:	8045 BIG BEND BLVD STE 107
Second Line	:
City	:	WEBSTER GROVES
State	:	MO
Zip	:	63119-2714
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1254 MAIN ST
Second Line	:
City	:	IMPERIAL
State	:	MO
Zip	:	63052-3861
Country	:	US
Telephone Number	:	636-741-3130
Fax Number	:	636-741-3131

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2017
Last Update Date	:	02/01/2024

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Directions to “ TINA ANDREWS ” Practice Location

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