Provider Demographics
NPI:1235788530
Name:LINZALONE, AMANDA (C-AA)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:LINZALONE
Suffix:
Gender:F
Credentials:C-AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17691 OAK CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ALVA
Mailing Address - State:FL
Mailing Address - Zip Code:33920-3555
Mailing Address - Country:US
Mailing Address - Phone:239-823-9315
Mailing Address - Fax:
Practice Address - Street 1:2776 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-5855
Practice Address - Country:US
Practice Address - Phone:239-343-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-09
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAA547367H00000X
367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant