Provider Demographics
NPI:1407073943
Name:AHAMMER, PAIGE MICHELLE (ARNP)
Entity Type:Individual
Prefix:MS
First Name:PAIGE
Middle Name:MICHELLE
Last Name:AHAMMER
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 1:221 W HIBISCUS BLVD
Mailing Address - Street 2:SUITE 401
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-3044
Mailing Address - Country:US
Mailing Address - Phone:321-258-9642
Mailing Address - Fax:321-821-5365
Practice Address - Street 1:221 W HIBISCUS BLVD
Practice Address - Street 2:SUITE 401
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3044
Practice Address - Country:US
Practice Address - Phone:321-258-9642
Practice Address - Fax:321-821-5365
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2838892363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMR540OtherMEDICARE PTAN