Provider Demographics
NPI:1144574476
Name:MICHAUD, AMANDA L (PA)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:L
Last Name:MICHAUD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:L
Other - Last Name:HESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:4123 UNIVERSITY BLVD S
Mailing Address - Street 2:STE B
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216
Mailing Address - Country:US
Mailing Address - Phone:904-636-9100
Mailing Address - Fax:904-636-9102
Practice Address - Street 1:4123 UNIVERSITY BLVD S
Practice Address - Street 2:STE B
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216
Practice Address - Country:US
Practice Address - Phone:904-636-9100
Practice Address - Fax:904-636-9102
Is Sole Proprietor?:No
Enumeration Date:2012-11-08
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5758363AM0700X
VA0110004013363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical