Provider Demographics
NPI:1174257216
Name:WASHINGTON, AMANDA L (APRN)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:L
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:869 JESSE DR
Mailing Address - Street 2:
Mailing Address - City:CANTONMENT
Mailing Address - State:FL
Mailing Address - Zip Code:32533-8197
Mailing Address - Country:US
Mailing Address - Phone:850-316-7923
Mailing Address - Fax:850-453-1196
Practice Address - Street 1:6715 W HIGHWAY 98
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32506-5923
Practice Address - Country:US
Practice Address - Phone:850-453-6737
Practice Address - Fax:850-453-1196
Is Sole Proprietor?:No
Enumeration Date:2022-07-14
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11020681363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily