Provider Demographics
NPI:1821397001
Name:RUTLEDGE, AMANDA CRICHLOW (MD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:CRICHLOW
Last Name:RUTLEDGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:VALERIE
Other - Last Name:CRICHLOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:232 HEATHERBROOKE CIR
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-6400
Mailing Address - Country:US
Mailing Address - Phone:856-217-8492
Mailing Address - Fax:
Practice Address - Street 1:7727 LAKE UNDERHILL RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-8224
Practice Address - Country:US
Practice Address - Phone:856-217-8492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-27
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME130563207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine