Provider Demographics
NPI:1871589101
Name:ADKINS, ANDREA DAWN (ARNP-C)
Entity type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:DAWN
Last Name:ADKINS
Suffix:
Gender:F
Credentials:ARNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 95004
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33804-5004
Mailing Address - Country:US
Mailing Address - Phone:863-680-7000
Mailing Address - Fax:863-680-7420
Practice Address - Street 1:4315 HIGHLAND PARK BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-1639
Practice Address - Country:US
Practice Address - Phone:863-816-5884
Practice Address - Fax:813-792-4745
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1645912363LF0000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDA5786OtherRAILROAD MEDICARE GROUP ID NUMBER / LRHSI
1497748743OtherGROUP NPI NUMBER/ LRHSI
FL306706800Medicaid
FLY8489YOtherMEDICARE PTAN / LRHSI
FL306706880Medicaid
FL306706800Medicaid
FLS97242Medicare UPIN
FLY8489WMedicare PIN