Provider Demographics
NPI:1740208149
Name:MCBRIDE, AMANDA LANE (ARNP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LANE
Last Name:MCBRIDE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 N 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-4604
Mailing Address - Country:US
Mailing Address - Phone:850-432-7310
Mailing Address - Fax:850-432-7320
Practice Address - Street 1:2510 N 12TH AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-4604
Practice Address - Country:US
Practice Address - Phone:850-432-7310
Practice Address - Fax:850-432-7320
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9186649363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health