Provider Demographics
NPI:1003519448
Name:TOMLINSON, AMANDA MARIE
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARIE
Last Name:TOMLINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2924 VANDEVER ST
Mailing Address - Street 2:
Mailing Address - City:BROOKEVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20833-2637
Mailing Address - Country:US
Mailing Address - Phone:301-787-2081
Mailing Address - Fax:
Practice Address - Street 1:2924 VANDEVER ST
Practice Address - Street 2:
Practice Address - City:BROOKEVILLE
Practice Address - State:MD
Practice Address - Zip Code:20833-2637
Practice Address - Country:US
Practice Address - Phone:301-787-2081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-24
Last Update Date:2023-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0008925363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant