Provider Demographics
NPI:1033317615
Name:PARRISH, AMANDA R (PA)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:R
Last Name:PARRISH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:A
Other - Last Name:RUSSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 357730
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32635-7730
Mailing Address - Country:US
Mailing Address - Phone:352-371-7546
Mailing Address - Fax:352-335-7546
Practice Address - Street 1:3700 NW 83RD ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-5603
Practice Address - Country:US
Practice Address - Phone:352-371-7546
Practice Address - Fax:352-335-7546
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9104201363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK4800Medicare PIN
FLAF035ZMedicare PIN