Provider Demographics
NPI:1659141943
Name:THORNGREN, AMANDA IRENE (MSN, FNP)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:IRENE
Last Name:THORNGREN
Suffix:
Gender:F
Credentials:MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8537 RIVERSIDE DR NE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-3750
Mailing Address - Country:US
Mailing Address - Phone:815-501-8073
Mailing Address - Fax:
Practice Address - Street 1:508 S HABANA AVE STE 210
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4161
Practice Address - Country:US
Practice Address - Phone:813-873-9010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11027946363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner