Provider Demographics
NPI:1568895589
Name:HARGROVE, AMANDA DEASE (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:DEASE
Last Name:HARGROVE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2065 E SOUTH BLVD STE 401
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36116-2462
Mailing Address - Country:US
Mailing Address - Phone:334-288-7808
Mailing Address - Fax:334-288-8089
Practice Address - Street 1:2065 E SOUTH BLVD STE 401
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-2462
Practice Address - Country:US
Practice Address - Phone:334-288-7808
Practice Address - Fax:334-288-8089
Is Sole Proprietor?:No
Enumeration Date:2013-08-13
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-100027363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner