Provider Demographics
NPI:1497488654
Name:CARD, AMY L (PMH-NP, BC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:CARD
Suffix:
Gender:F
Credentials:PMH-NP, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 W WINDHORST RD
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33510-2455
Mailing Address - Country:US
Mailing Address - Phone:850-766-8516
Mailing Address - Fax:
Practice Address - Street 1:106 W WINDHORST RD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510-2455
Practice Address - Country:US
Practice Address - Phone:813-373-9531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-06
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11020232363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health