Provider Demographics
NPI:1710610852
Name:SKONECKI, AMY BOULTON (APRN)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:BOULTON
Last Name:SKONECKI
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 N 75TH AVE
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32506-3820
Mailing Address - Country:US
Mailing Address - Phone:850-434-0077
Mailing Address - Fax:850-434-0220
Practice Address - Street 1:15 W MAXWELL ST STE 148
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-1700
Practice Address - Country:US
Practice Address - Phone:850-434-0077
Practice Address - Fax:850-434-0220
Is Sole Proprietor?:No
Enumeration Date:2022-07-06
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11020369363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology