Provider Demographics
NPI:1679242366
Name:CROWLEY, AMANDA JO I (FNP)
Entity Type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:JO
Last Name:CROWLEY
Suffix:I
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31754 RED TAIL BLVD
Mailing Address - Street 2:
Mailing Address - City:SORRENTO
Mailing Address - State:FL
Mailing Address - Zip Code:32776-7764
Mailing Address - Country:US
Mailing Address - Phone:941-525-7258
Mailing Address - Fax:
Practice Address - Street 1:165 WEKIVA SPRINGS RD STE C
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-6051
Practice Address - Country:US
Practice Address - Phone:941-525-7258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-07
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF08210115363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily