Provider Demographics
NPI:1093147019
Name:SPENCE, AMANDA MARIE (CPNP-PC)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:MARIE
Last Name:SPENCE
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:MAZUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4266 SUNBEAM RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-2425
Mailing Address - Country:US
Mailing Address - Phone:904-463-4770
Mailing Address - Fax:904-202-8549
Practice Address - Street 1:4266 SUNBEAM RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-2425
Practice Address - Country:US
Practice Address - Phone:904-463-4770
Practice Address - Fax:904-202-8549
Is Sole Proprietor?:No
Enumeration Date:2013-08-01
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9404125363LP0200X
OHCOA14920-NP,RN344880363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics