Provider Demographics
NPI:1578552725
Name:SCHULTZ, AMANDA (PAC)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:MS
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:GRECO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PAC
Mailing Address - Street 1:1890 SW HEALTH PKWY STE 303
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-0473
Mailing Address - Country:US
Mailing Address - Phone:239-593-0990
Mailing Address - Fax:239-593-0007
Practice Address - Street 1:1890 SW HEALTH PKWY STE 303
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109
Practice Address - Country:US
Practice Address - Phone:239-593-0990
Practice Address - Fax:239-593-0007
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102133363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL291565100Medicaid
P74402Medicare UPIN