Provider Demographics
NPI:1184668394
Name:STERN, AMY J (ARNP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:J
Last Name:STERN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5460 63RD STREET EAST SUITE A
Mailing Address - Street 2:FAMILY HOME PHYSICIANS
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34203
Mailing Address - Country:US
Mailing Address - Phone:941-758-0379
Mailing Address - Fax:941-727-7503
Practice Address - Street 1:5460 63RD ST E
Practice Address - Street 2:SUITE A
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34203-7808
Practice Address - Country:US
Practice Address - Phone:941-758-0379
Practice Address - Fax:941-727-7503
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9240880363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK07995Medicare ID - Type UnspecifiedMEDICARE #