Provider Demographics
NPI:1346580198
Name:FOX, AMANDA E (ARNP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:E
Last Name:FOX
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11801 PANAMA CITY BEACH PKWY
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32407-2509
Mailing Address - Country:US
Mailing Address - Phone:866-389-2727
Mailing Address - Fax:850-230-6433
Practice Address - Street 1:11801 PANAMA CITY BEACH PKWY
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32407-2509
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:850-230-6433
Is Sole Proprietor?:No
Enumeration Date:2013-02-14
Last Update Date:2023-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9265114363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL023274000Medicaid
FLJF797ZOtherMEDICARE
SCSC0741A6067Medicare PIN