Provider Demographics
NPI:1295378248
Name:GICKA, AMANDA MICHELLE (APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:MICHELLE
Last Name:GICKA
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:MICHELLE
Other - Last Name:BARRETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN,FNP-BC
Mailing Address - Street 1:2150 49TH ST N STE A
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-5237
Mailing Address - Country:US
Mailing Address - Phone:727-828-1730
Mailing Address - Fax:727-828-1731
Practice Address - Street 1:2150 49TH ST N STE A
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-5237
Practice Address - Country:US
Practice Address - Phone:727-828-1730
Practice Address - Fax:727-828-1731
Is Sole Proprietor?:No
Enumeration Date:2019-10-22
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11004322363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105036900Medicaid