Provider Demographics
NPI:1376864264
Name:LEE, AMANDA BRYN (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:BRYN
Last Name:LEE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MISS
Other - First Name:AMANDA
Other - Middle Name:BRYN
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:11505 PALMBRUSH TRL # 200
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-2917
Mailing Address - Country:US
Mailing Address - Phone:941-361-1100
Mailing Address - Fax:
Practice Address - Street 1:11505 PALMBRUSH TRL # 200
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-2917
Practice Address - Country:US
Practice Address - Phone:941-361-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-15
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9190072363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily