Provider Demographics
NPI:1649749466
Name:GORDON, AMANDA (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9413 BLAZING STAR TRL
Mailing Address - Street 2:
Mailing Address - City:GARDEN RIDGE
Mailing Address - State:TX
Mailing Address - Zip Code:78266-2313
Mailing Address - Country:US
Mailing Address - Phone:512-367-3277
Mailing Address - Fax:
Practice Address - Street 1:19272 STONE OAK PKWY STE 101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3372
Practice Address - Country:US
Practice Address - Phone:210-265-8851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-21
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139802207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine