Provider Demographics
NPI:1790034908
Name:GARCIA, AMANDA GRUNDEN (APRN)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:GRUNDEN
Last Name:GARCIA
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 1:900 S PINE ISLAND RD STE 800
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3923
Mailing Address - Country:US
Mailing Address - Phone:813-699-3995
Mailing Address - Fax:813-315-1625
Practice Address - Street 1:901 E BLOOMINGDALE AVE STE 501
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-8118
Practice Address - Country:US
Practice Address - Phone:813-699-3995
Practice Address - Fax:813-315-1625
Is Sole Proprietor?:No
Enumeration Date:2012-09-04
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11025356363L00000X, 363LF0000X
TX758148363LF0000X
TXAP122055363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB162675Medicare PIN
TXTXB162674Medicare PIN
TXTXB162679Medicare PIN