Provider Demographics
NPI:1598942237
Name:ANDERSEN, AMY (ARNP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:ANDERSEN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:ANDERSEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP
Mailing Address - Street 1:5357 EHRLICH RD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33625-5505
Mailing Address - Country:US
Mailing Address - Phone:813-968-4003
Mailing Address - Fax:
Practice Address - Street 1:5357 EHRLICH RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33625-5505
Practice Address - Country:US
Practice Address - Phone:813-968-4003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-24
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1359622363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1598942237OtherNPI
FLY6756YMedicare PIN