Provider Demographics
NPI:1609962406
Name:DOUB, AMY E (PA-C)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:E
Last Name:DOUB
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13701 BRUCE B DOWNS BLVD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613
Mailing Address - Country:US
Mailing Address - Phone:813-977-4767
Mailing Address - Fax:813-977-6275
Practice Address - Street 1:13701 BRUCE B DOWNS BLVD
Practice Address - Street 2:SUITE 115
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613
Practice Address - Country:US
Practice Address - Phone:813-977-4767
Practice Address - Fax:813-977-6275
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 9101020363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS89549Medicare UPIN
FLE3098VMedicare ID - Type UnspecifiedMEDICARE NUMBER