Provider Demographics
NPI:1871033340
Name:CHISSELL, AMANDA LINS (PA-C)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LINS
Last Name:CHISSELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:E
Other - Last Name:LINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13801 BRUCE B DOWNS BLVD STE 231
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-3946
Mailing Address - Country:US
Mailing Address - Phone:813-345-2380
Mailing Address - Fax:813-877-6708
Practice Address - Street 1:13801 BRUCE B DOWNS BLVD STE 231
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-3946
Practice Address - Country:US
Practice Address - Phone:813-345-2380
Practice Address - Fax:813-877-6708
Is Sole Proprietor?:No
Enumeration Date:2017-03-03
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9110213363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical