Provider Demographics
NPI:1760883219
Name:ROGAN, AMANDA LEE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:LEE
Last Name:ROGAN
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:5979 VINELAND RD STE 101
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-7860
Mailing Address - Country:US
Mailing Address - Phone:407-355-3120
Mailing Address - Fax:407-355-3119
Practice Address - Street 1:5979 VINELAND RD STE 101
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-7860
Practice Address - Country:US
Practice Address - Phone:407-355-3120
Practice Address - Fax:407-355-3119
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-15
Last Update Date:2022-05-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPAT9108155363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical