Basic Information
Provider Information | |||||||||
NPI: | 1437406063 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ANDREWS | ||||||||
FirstName: | SANDRA | ||||||||
MiddleName: | LAVANDIER | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | ARNP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | LAVANDIER | ||||||||
OtherFirstName: | SANDRA | ||||||||
OtherMiddleName: | ALTAGRACIA | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 44008 | ||||||||
Address2: | UFJP - PROVIDER ENROLLMENT | ||||||||
City: | JACKSONVILLE | ||||||||
State: | FL | ||||||||
PostalCode: | 322314008 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9042443199 | ||||||||
FaxNumber: | 9042443425 | ||||||||
Practice Location | |||||||||
Address1: | 580 W 8TH ST | ||||||||
Address2: | UFJAX - DEPT. OF NEUROLOGY | ||||||||
City: | JACKSONVILLE | ||||||||
State: | FL | ||||||||
PostalCode: | 322096533 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9042443960 | ||||||||
FaxNumber: | 9042449493 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/14/2012 | ||||||||
LastUpdateDate: | 10/21/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | ARNP9250436 | FL | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
ID | Type | State | Issuer | Description | 007320000 | 05 | FL |   | MEDICAID | 003128080A | 05 | GA |   | MEDICAID | 003128080B | 05 | GA |   | MEDICAID |