Provider Demographics
NPI:1003371642
Name:SIEGEL, AMBER JANE (APRN)
Entity Type:Individual
Prefix:DR
First Name:AMBER
Middle Name:JANE
Last Name:SIEGEL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:J
Other - Last Name:SIEGEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AGNP-C
Mailing Address - Street 1:1510 E COLONIAL DR STE 230
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-4734
Mailing Address - Country:US
Mailing Address - Phone:407-410-4201
Mailing Address - Fax:407-550-1329
Practice Address - Street 1:1510 E COLONIAL DR STE 230
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-4734
Practice Address - Country:US
Practice Address - Phone:315-286-9748
Practice Address - Fax:407-550-1329
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-07
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11001385363LA2200X, 363LP2300X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
11001385OtherI DO NOT HAVE ANY OTHER NUMBER
FL104856000Medicaid