Provider Demographics
NPI:1861501363
Name:EARL, AMANDA E (PA-C)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:E
Last Name:EARL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9149 ESTATE THOMAS
Mailing Address - Street 2:SUITE 1074
Mailing Address - City:ST THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00802-2615
Mailing Address - Country:US
Mailing Address - Phone:340-714-2845
Mailing Address - Fax:603-924-3993
Practice Address - Street 1:9149 ESTATE THOMAS PARAGON MEDICAL BUILDING
Practice Address - Street 2:SUITE 104
Practice Address - City:ST. THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802
Practice Address - Country:US
Practice Address - Phone:340-714-2845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0337P363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30331366Medicaid
AP1287Medicare UPIN
NH30331366Medicaid