Provider Demographics
NPI:1285202010
Name:MASCOE, AMANDA LYNNE (APRN)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LYNNE
Last Name:MASCOE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:LYNNE
Other - Last Name:RILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:1700 S TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-3509
Mailing Address - Country:US
Mailing Address - Phone:941-917-4896
Mailing Address - Fax:941-917-6884
Practice Address - Street 1:5114 NE COUNTY ROAD 660
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:FL
Practice Address - Zip Code:34266-5792
Practice Address - Country:US
Practice Address - Phone:941-769-6688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-17
Last Update Date:2024-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11013715363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily