Provider Demographics
NPI:1164660965
Name:HOEKJE, ANDREA MARIE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:MARIE
Last Name:HOEKJE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:MARIE
Other - Last Name:TARDIVO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 72
Mailing Address - Street 2:5861 MASON DIXON HIGHWAY
Mailing Address - City:BLACKSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26521
Mailing Address - Country:US
Mailing Address - Phone:304-432-8211
Mailing Address - Fax:304-432-8213
Practice Address - Street 1:5861 MASON DIXON HIGHWAY
Practice Address - Street 2:
Practice Address - City:BLACKSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26521
Practice Address - Country:US
Practice Address - Phone:304-432-8211
Practice Address - Fax:304-432-8213
Is Sole Proprietor?:No
Enumeration Date:2009-02-02
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA053785363AS0400X
VA01463363A00000X
WV01463363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVPA36001Medicare PIN
WVPA36002Medicare PIN
VAPA36002Medicare PIN