Provider Demographics
NPI:1609276732
Name:SELF, AMANDA RACHEL (FNP-C)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:RACHEL
Last Name:SELF
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4724 N DAVIS HWY
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2339
Mailing Address - Country:US
Mailing Address - Phone:850-696-4000
Mailing Address - Fax:850-696-4000
Practice Address - Street 1:2114 CREIGHTON RD STE A
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-7218
Practice Address - Country:US
Practice Address - Phone:850-696-4000
Practice Address - Fax:850-434-2647
Is Sole Proprietor?:No
Enumeration Date:2014-08-26
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9392793363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003154313Medicaid
AL168604Medicaid
AL168604Medicaid