Provider Demographics
NPI:1376761486
Name:WHISNANT, AMANDA (APRN)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:WHISNANT
Suffix:
Gender:F
Credentials:APRN
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 2429
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-8429
Mailing Address - Country:US
Mailing Address - Phone:972-420-1475
Mailing Address - Fax:469-671-5437
Practice Address - Street 1:4570 LYONS RD STE 110
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-3481
Practice Address - Country:US
Practice Address - Phone:954-971-3210
Practice Address - Fax:954-971-3427
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2674363L00000X
FLAPRN9272409363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL100564800Medicaid