Provider Demographics
NPI:1861508392
Name:POLLEY, ANDREA ALEXANDRA (ARNP)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:ALEXANDRA
Last Name:POLLEY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 7TH ST S
Mailing Address - Street 2:SUITE 350
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4719
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:603 7TH ST S
Practice Address - Street 2:SUITE 350
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4719
Practice Address - Country:US
Practice Address - Phone:727-553-7474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 3187052363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL307607500Medicaid
FL307607500Medicaid
FLU0322ZMedicare PIN
500030669Medicare PIN