Provider Demographics
NPI:1548605975
Name:SCACE, ANDREA N (FNP)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:N
Last Name:SCACE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 FROSTWOOD DR
Mailing Address - Street 2:SUITE 1.100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2301
Mailing Address - Country:US
Mailing Address - Phone:713-338-4523
Mailing Address - Fax:
Practice Address - Street 1:19675 I 45 S
Practice Address - Street 2:SUITE 100
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77385-8761
Practice Address - Country:US
Practice Address - Phone:281-465-2873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-29
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC237528363L00000X
TXAP129901363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCFH4001420OtherFIRST MEDICARE DIRECT
NCFH4001420OtherFIRST CAROLINA CARE, INC
NCP01210648OtherR/R MEDICARE
NCP01210648OtherR/R MEDICARE