Provider Demographics
NPI:1346519261
Name:BATLLE, AMANDA BRANTLEY (CPNP)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:BRANTLEY
Last Name:BATLLE
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:MORAIN
Other - Last Name:BRANTLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP
Mailing Address - Street 1:3284 WILTSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:AVONDALE ESTATES
Mailing Address - State:GA
Mailing Address - Zip Code:30002-1638
Mailing Address - Country:US
Mailing Address - Phone:678-793-0542
Mailing Address - Fax:
Practice Address - Street 1:3284 WILTSHIRE DR
Practice Address - Street 2:
Practice Address - City:AVONDALE ESTATES
Practice Address - State:GA
Practice Address - Zip Code:30002-1638
Practice Address - Country:US
Practice Address - Phone:678-793-0542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-21
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN214358363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics