Provider Demographics
NPI:1679988299
Name:BICKERTON, ANDREA (MD)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:BICKERTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8855 IMMOKALEE RD UNIT 11
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34120-3928
Mailing Address - Country:US
Mailing Address - Phone:239-302-3540
Mailing Address - Fax:239-302-3535
Practice Address - Street 1:8855 IMMOKALEE RD UNIT 11
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34120-3928
Practice Address - Country:US
Practice Address - Phone:239-302-3540
Practice Address - Fax:239-302-3535
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-23
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2014020152207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine