Provider Demographics
NPI:1891476719
Name:AMBUEHL, GARRETT LEVI (AGPCNP-C)
Entity Type:Individual
Prefix:MR
First Name:GARRETT
Middle Name:LEVI
Last Name:AMBUEHL
Suffix:
Gender:M
Credentials:AGPCNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 RIVERPLACE BLVD APT 1602
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-9095
Mailing Address - Country:US
Mailing Address - Phone:618-267-0160
Mailing Address - Fax:
Practice Address - Street 1:1401 RIVERPLACE BLVD APT 1602
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-9095
Practice Address - Country:US
Practice Address - Phone:618-267-0160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-25
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11025517363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care