Provider Demographics
NPI:1023207891
Name:DRAB, AMY M (PA)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:M
Last Name:DRAB
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4006 SUGARCANE CREEK RUN
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-1528
Mailing Address - Country:US
Mailing Address - Phone:850-543-1985
Mailing Address - Fax:
Practice Address - Street 1:2600 PARTIN DR N STE 110
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-1543
Practice Address - Country:US
Practice Address - Phone:850-517-6578
Practice Address - Fax:850-810-5488
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-17
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA-529363AM0700X, 363AM0700X
FLPA9107391363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA9107391OtherSTATE OF FLORIDA LICENSE FOR PHYSICIAN ASSISTANT