Provider Demographics
NPI:1902456106
Name:POLLARD, ANDRE'
Entity Type:Individual
Prefix:MR
First Name:ANDRE'
Middle Name:
Last Name:POLLARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13700 SUTTON PARK DR N APT 1313
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-2277
Mailing Address - Country:US
Mailing Address - Phone:610-636-3250
Mailing Address - Fax:
Practice Address - Street 1:13700 SUTTON PARK DR N APT 1313
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-2277
Practice Address - Country:US
Practice Address - Phone:904-551-4926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-19
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL116915932OtherD&B