Provider Demographics
NPI:1083926505
Name:GANO, AMANDA LYNN (PA-C)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LYNN
Last Name:GANO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:LYNN
Other - Last Name:AULT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:33 WATER TUPELO LN
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-7681
Mailing Address - Country:US
Mailing Address - Phone:607-483-8550
Mailing Address - Fax:
Practice Address - Street 1:845 WILLIAM HILTON PKWY
Practice Address - Street 2:
Practice Address - City:HILTON HEAD
Practice Address - State:SC
Practice Address - Zip Code:29928-3404
Practice Address - Country:US
Practice Address - Phone:843-321-2416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCPA2684363AM0700X
PAMA053995363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical