Provider Demographics
NPI:1659880995
Name:GRUBER, AMANDA PAIGE (AGPCNP)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:PAIGE
Last Name:GRUBER
Suffix:
Gender:F
Credentials:AGPCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7777 FOREST LN STE A341
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2500
Mailing Address - Country:US
Mailing Address - Phone:972-566-5700
Mailing Address - Fax:844-290-4358
Practice Address - Street 1:7777 FOREST LN STE A341
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2500
Practice Address - Country:US
Practice Address - Phone:972-566-5700
Practice Address - Fax:844-290-4358
Is Sole Proprietor?:No
Enumeration Date:2017-09-28
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP134533363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP134533OtherAPRN