Provider Demographics
NPI:1437712346
Name:LANGE, AMANDA CATHERINE
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:CATHERINE
Last Name:LANGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7243 DELLA DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-5104
Mailing Address - Country:US
Mailing Address - Phone:321-841-2800
Mailing Address - Fax:321-843-3574
Practice Address - Street 1:7243 DELLA DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-5104
Practice Address - Country:US
Practice Address - Phone:321-841-2800
Practice Address - Fax:321-843-3574
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-16
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program