Provider Demographics
NPI:1669958641
Name:DAVIN, ANDREA DIANE (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:DIANE
Last Name:DAVIN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:DIANE
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 TROTTER RD APT 416
Mailing Address - Street 2:
Mailing Address - City:SOUTH WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190-3825
Mailing Address - Country:US
Mailing Address - Phone:508-566-7342
Mailing Address - Fax:
Practice Address - Street 1:94 OBERY ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360
Practice Address - Country:US
Practice Address - Phone:508-747-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-13
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2272742363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily