Provider Demographics
NPI:1679038921
Name:GARCIA, AMANDA NICOLE (NP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:NICOLE
Last Name:GARCIA
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 1:106 CIRCLE WAY ST
Mailing Address - Street 2:
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-5266
Mailing Address - Country:US
Mailing Address - Phone:979-529-2371
Mailing Address - Fax:979-529-2564
Practice Address - Street 1:106 CIRCLE WAY ST
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-5266
Practice Address - Country:US
Practice Address - Phone:979-529-2371
Practice Address - Fax:979-529-2564
Is Sole Proprietor?:No
Enumeration Date:2019-01-31
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP138402363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily