Provider Demographics
NPI:1437645439
Name:AMANDA NUGENT PA
Entity Type:Organization
Organization Name:AMANDA NUGENT PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:C
Authorized Official - Last Name:NUGENT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:561-683-2621
Mailing Address - Street 1:3332 NW FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34957-4402
Mailing Address - Country:US
Mailing Address - Phone:777-692-4900
Mailing Address - Fax:772-261-6068
Practice Address - Street 1:3332 NW FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:JENSEN BEACH
Practice Address - State:FL
Practice Address - Zip Code:34957-4402
Practice Address - Country:US
Practice Address - Phone:777-692-4900
Practice Address - Fax:772-261-6068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-03
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty