Provider Demographics
NPI:1568618593
Name:EGAN, AMY GARTLAND (MD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:GARTLAND
Last Name:EGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4811 ISLAND POND CT UNIT 805
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134-8780
Mailing Address - Country:US
Mailing Address - Phone:301-943-0820
Mailing Address - Fax:
Practice Address - Street 1:4811 ISLAND POND CT UNIT 805
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-8780
Practice Address - Country:US
Practice Address - Phone:301-943-0820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-11
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0058310261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center