Provider Demographics
NPI:1689780959
Name:KOWALSKI, AMANDA (PA-C)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:KOWALSKI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 CATTLEMEN RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-6056
Mailing Address - Country:US
Mailing Address - Phone:941-379-1799
Mailing Address - Fax:941-379-1899
Practice Address - Street 1:3333 CATTLEMEN RD
Practice Address - Street 2:SUITE 106
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-6056
Practice Address - Country:US
Practice Address - Phone:941-379-1799
Practice Address - Fax:941-379-1899
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA 051508363AM0700X
FLPA 9103694363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAA524ZMedicare PIN