Provider Demographics
NPI:1497022776
Name:SMITHERMAN, AMANDA (CRNP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:SMITHERMAN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16181 PANAMA CITY BEACH PKWY
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32413-5423
Mailing Address - Country:US
Mailing Address - Phone:850-249-1000
Mailing Address - Fax:850-249-1009
Practice Address - Street 1:16181 PANAMA CITY BEACH PKWY
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32413-5423
Practice Address - Country:US
Practice Address - Phone:850-249-1000
Practice Address - Fax:850-249-1009
Is Sole Proprietor?:No
Enumeration Date:2011-11-30
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9347890363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily