Provider Demographics
NPI:1669911210
Name:SKULIMOSKI, ANDREA (NP-C)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:
Last Name:SKULIMOSKI
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:POLICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1324 LAKELAND HILLS BLVD
Mailing Address - Street 2:ATTN: MANAGED CARE DEPT.
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-4543
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:130 PABLO ST
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-3818
Practice Address - Country:US
Practice Address - Phone:863-284-5997
Practice Address - Fax:863-284-5979
Is Sole Proprietor?:No
Enumeration Date:2017-02-15
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9325052363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health