Provider Demographics
NPI:1407574080
Name:GOLDEN, AMANDA RENE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:RENE
Last Name:GOLDEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 MEDICAL PARK LN STE C
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77340-4957
Mailing Address - Country:US
Mailing Address - Phone:936-291-3219
Mailing Address - Fax:
Practice Address - Street 1:125 MEDICAL PARK LN STE C
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-4957
Practice Address - Country:US
Practice Address - Phone:936-291-3219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-18
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1090291363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily