MEDICARE: ANDREA DZIWULSKI PA

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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1922831585
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA DZIWULSKI PA

Provider Business Mailing Address
First Line	:	2025 COUNTY ROAD 209B
Second Line	:
City	:	GREEN COVE SPRINGS
State	:	FL
Zip	:	32043-5103
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6801 BEACH BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-2820
Country	:	US
Telephone Number	:	904-224-5437
Fax Number	:

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

Provider Enumeration Date	:	08/20/2024
Last Update Date	:	08/20/2024

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Directions to “ ANDREA DZIWULSKI PA” Practice Location

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