Provider Demographics
NPI:1477002194
Name:INGLE, AMY LYNNE (APRN)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LYNNE
Last Name:INGLE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11621 S CLEVELAND AVE STE 60
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-2866
Mailing Address - Country:US
Mailing Address - Phone:239-789-3098
Mailing Address - Fax:
Practice Address - Street 1:11621 S CLEVELAND AVE STE 60
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-2866
Practice Address - Country:US
Practice Address - Phone:239-789-3098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-22
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9186384363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021956000Medicaid