Provider Demographics
NPI:1518075399
Name:COYLE, AMANDA LEE (NP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEE
Last Name:COYLE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:LEE
Other - Last Name:GRANIER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:301 RIVERVIEW AVE STE 930
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-1068
Mailing Address - Country:US
Mailing Address - Phone:757-252-3236
Mailing Address - Fax:
Practice Address - Street 1:301 RIVERVIEW AVE STE 930
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-1068
Practice Address - Country:US
Practice Address - Phone:757-252-3236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024180190363L00000X, 363LF0000X
NY335000363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDMC1460031OtherOTHER
NYRB3195Medicare PIN
NYRB3194Medicare PIN