Provider Demographics
NPI:1891984977
Name:MURPHY, AMY MARIE (PA-C,MMS)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MARIE
Last Name:MURPHY
Suffix:
Gender:F
Credentials:PA-C,MMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21550 ANGELA LN
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293-2017
Mailing Address - Country:US
Mailing Address - Phone:941-493-7400
Mailing Address - Fax:941-493-1940
Practice Address - Street 1:21550 ANGELA LN
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34293-2017
Practice Address - Country:US
Practice Address - Phone:941-493-7400
Practice Address - Fax:941-493-1940
Is Sole Proprietor?:No
Enumeration Date:2007-10-15
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9104393363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAH180ZMedicare PIN