Provider Demographics
NPI:1518194125
Name:FLORENCE, AMBER RAE
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:RAE
Last Name:FLORENCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:RAE
Other - Last Name:KISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1200 COLLEGE AVENUE
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-3908
Mailing Address - Country:US
Mailing Address - Phone:701-568-2300
Mailing Address - Fax:701-568-2304
Practice Address - Street 1:1200 COLLEGE AVENUE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-3908
Practice Address - Country:US
Practice Address - Phone:701-568-2300
Practice Address - Fax:701-568-2304
Is Sole Proprietor?:No
Enumeration Date:2009-06-22
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator