Provider Demographics
NPI:1548801954
Name:DEMONBREUN, AMY J (APRN)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:J
Last Name:DEMONBREUN
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 1:395 COMMERCIAL CT STE E
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34292-1651
Mailing Address - Country:US
Mailing Address - Phone:941-486-1404
Mailing Address - Fax:941-486-4146
Practice Address - Street 1:395 COMMERCIAL CT STE E
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-1651
Practice Address - Country:US
Practice Address - Phone:941-486-1404
Practice Address - Fax:941-486-4146
Is Sole Proprietor?:No
Enumeration Date:2019-10-07
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11004440363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner