Provider Demographics
NPI:1710876933
Name:BLIZZARD, ANDRE LOTRICK (LPN)
Entity type:Individual
Prefix:
First Name:ANDRE
Middle Name:LOTRICK
Last Name:BLIZZARD
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 GATEWAY RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-8123
Mailing Address - Country:US
Mailing Address - Phone:470-885-3990
Mailing Address - Fax:
Practice Address - Street 1:1600 GATEWAY RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-8123
Practice Address - Country:US
Practice Address - Phone:470-885-3990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-01
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0002061531164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse