Provider Demographics
NPI:1740383181
Name:AMANZE, MARIE MICHELLE (MD)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:MICHELLE
Last Name:AMANZE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:MICHELLE
Other - Last Name:PLANTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1309 THOMASWOOD DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-7915
Mailing Address - Country:US
Mailing Address - Phone:850-727-8540
Mailing Address - Fax:850-765-8674
Practice Address - Street 1:1309 THOMASWOOD DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-7915
Practice Address - Country:US
Practice Address - Phone:850-727-8540
Practice Address - Fax:850-765-8674
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME94463207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL30319OtherFLORIDA BLUE
FL30319OtherFLORIDA BLUE
H45481Medicare UPIN