Provider Demographics
NPI:1073667861
Name:MURPHY, AMANDA STOLL (PA-C)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:STOLL
Last Name:MURPHY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:MARIE
Other - Last Name:STOLL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:151 SOUTHHALL LN
Mailing Address - Street 2:STE 300
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-7172
Mailing Address - Country:US
Mailing Address - Phone:407-875-2080
Mailing Address - Fax:407-650-3455
Practice Address - Street 1:501 OFFICE CENTER DR
Practice Address - Street 2:SUITE 195
Practice Address - City:FORT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:19034-3220
Practice Address - Country:US
Practice Address - Phone:215-836-7900
Practice Address - Fax:215-836-7900
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051045363A00000X
PAOA002353363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARAILROAD MEDICAREOtherP00125664
PA072193Medicare ID - Type Unspecified
PAP95637Medicare UPIN