Provider Demographics
NPI:1104853704
Name:PORTER, AMANDA RENEA (PA-C)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:RENEA
Last Name:PORTER
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:5400 PINEHURST DR
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606-3833
Mailing Address - Country:US
Mailing Address - Phone:352-277-5348
Mailing Address - Fax:352-606-2857
Practice Address - Street 1:14555 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-6003
Practice Address - Country:US
Practice Address - Phone:352-556-4823
Practice Address - Fax:352-556-4824
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2023-12-22
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Provider Licenses
StateLicense IDTaxonomies
FLPA9107321363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant