Provider Demographics
NPI:1174841241
Name:MACHER, AMY NICHOLE (MD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:NICHOLE
Last Name:MACHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6170 ULMERTON RD STE 101
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33760-3950
Mailing Address - Country:US
Mailing Address - Phone:727-532-7661
Mailing Address - Fax:727-561-9865
Practice Address - Street 1:6170 ULMERTON RD STE 101
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33760-3950
Practice Address - Country:US
Practice Address - Phone:727-532-7661
Practice Address - Fax:727-561-9865
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-13
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY271634207P00000X
FLME119919207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLJO979Medicaid
NYJ400096415Medicare PIN