Provider Demographics
NPI:1588003990
Name:FRELICHE, AMY CAROLINE (NP-C)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:CAROLINE
Last Name:FRELICHE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 RUTLEDGE AVE
Mailing Address - Street 2:MSC 550
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29425-5500
Mailing Address - Country:US
Mailing Address - Phone:843-792-7165
Mailing Address - Fax:843-792-0546
Practice Address - Street 1:135 RUTLEDGE AVE
Practice Address - Street 2:MSC 550
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29425-5500
Practice Address - Country:US
Practice Address - Phone:843-792-8733
Practice Address - Fax:843-792-0546
Is Sole Proprietor?:No
Enumeration Date:2013-06-19
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9380625363L00000X
SC18217363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012820900Medicaid
FLHW948ZMedicare PIN