Provider Demographics
NPI:1629436282
Name:GASKIN, AMANDA (ARNP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:GASKIN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:733 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-4441
Mailing Address - Country:US
Mailing Address - Phone:352-901-6582
Mailing Address - Fax:352-657-1844
Practice Address - Street 1:733 N 3RD ST
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-4441
Practice Address - Country:US
Practice Address - Phone:352-901-6582
Practice Address - Fax:352-657-1844
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-10
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9248510163W00000X
FLAPRN9248510202D00000X
FLARNP 9248510363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No202D00000XAllopathic & Osteopathic PhysiciansIntegrative MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016884700Medicaid
FLIN290ZMedicare PIN