Provider Demographics
NPI:1265672877
Name:REID, AMANDA LOIS (APRN)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LOIS
Last Name:REID
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:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-424-1500
Mailing Address - Fax:239-343-4145
Practice Address - Street 1:8925 COLONIAL CENTER DR STE 2001
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33905-7813
Practice Address - Country:US
Practice Address - Phone:239-343-9567
Practice Address - Fax:239-343-9571
Is Sole Proprietor?:No
Enumeration Date:2009-02-23
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9184663363L00000X
FLAPRN9184663363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000866900Medicaid
FLRN 9184663OtherLICENSE
FL000866900Medicaid