Provider Demographics
NPI:1467172148
Name:TOMASIK, AMANDA JANE (ACCNS-AG)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:JANE
Last Name:TOMASIK
Suffix:
Gender:F
Credentials:ACCNS-AG
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2594 MOUNT HOPE RD
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-2445
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2594 MOUNT HOPE RD
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-2445
Practice Address - Country:US
Practice Address - Phone:919-998-8086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-01
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704287064364SA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAcute Care