Provider Demographics
NPI:1811221484
Name:HUFFMAN, AMANDA K (APRN)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:K
Last Name:HUFFMAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:941-255-3722
Mailing Address - Fax:941-255-3723
Practice Address - Street 1:22655 BAYSHORE RD STE 130
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33980
Practice Address - Country:US
Practice Address - Phone:941-255-3722
Practice Address - Fax:941-255-3723
Is Sole Proprietor?:No
Enumeration Date:2009-09-29
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9272299364S00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019097600Medicaid
FL019097600Medicaid
FLP00919148OtherRAILROAD MEDICARE
FLEQ127XMedicare PIN
FLEQ127ZMedicare PIN