Provider Demographics
NPI:1629835541
Name:LANGKOP, AMANDA ELAINE (NP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:ELAINE
Last Name:LANGKOP
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 BRYANT ST
Mailing Address - Street 2:
Mailing Address - City:POTTSBORO
Mailing Address - State:TX
Mailing Address - Zip Code:75076-7457
Mailing Address - Country:US
Mailing Address - Phone:972-904-8562
Mailing Address - Fax:
Practice Address - Street 1:10101 GROSVENOR PL APT 1102
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-4675
Practice Address - Country:US
Practice Address - Phone:972-904-8562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024189661363LF0000X
TX1153289363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily