Provider Demographics
NPI:1326440199
Name:DREVE, AMANDA (PA)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:DREVE
Suffix:
Gender:F
Credentials:PA
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 210127
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37221-0127
Mailing Address - Country:US
Mailing Address - Phone:615-383-2443
Mailing Address - Fax:615-383-0853
Practice Address - Street 1:330 22ND AVE N
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1844
Practice Address - Country:US
Practice Address - Phone:615-320-0007
Practice Address - Fax:615-902-3983
Is Sole Proprietor?:No
Enumeration Date:2014-09-23
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2620363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ009554Medicaid
TNQ009554Medicaid
TN103I970316Medicare PIN