Provider Demographics
NPI:1790266237
Name:COBB, AMY (AGNP-C)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:COBB
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8776 CHRISTIE DR
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-6405
Mailing Address - Country:US
Mailing Address - Phone:727-709-0376
Mailing Address - Fax:
Practice Address - Street 1:8776 CHRISTIE DR
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-6405
Practice Address - Country:US
Practice Address - Phone:727-709-0376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-23
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9169241363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP9169241OtherFL ARNP LICENSE
FLRN9169241OtherFL RN LICENSE