Provider Demographics
NPI:1558550806
Name:GOODS, AMANDA LEIGH (PA)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEIGH
Last Name:GOODS
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:1988 GULF TO BAY BLVD
Mailing Address - Street 2:STE 1
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-3550
Mailing Address - Country:US
Mailing Address - Phone:727-953-8090
Mailing Address - Fax:727-953-8088
Practice Address - Street 1:3001 BEE CAVES RD
Practice Address - Street 2:STE 200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-5590
Practice Address - Country:US
Practice Address - Phone:512-454-1234
Practice Address - Fax:512-472-7350
Is Sole Proprietor?:No
Enumeration Date:2007-10-22
Last Update Date:2016-06-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXPA05831363AS0400X
CAPA22881363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
8L2449Medicare PIN