Provider Demographics
NPI:1902379555
Name:TORDOFF, AMBER LEIGH
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:LEIGH
Last Name:TORDOFF
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:AMBER
Other - Middle Name:LEIGH
Other - Last Name:ROSSER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CAPT TORDOFF
Mailing Address - Street 1:BENNETT AVENUE
Mailing Address - Street 2:BUILDING 90747
Mailing Address - City:HURLBURT FIELD
Mailing Address - State:FL
Mailing Address - Zip Code:32548
Mailing Address - Country:US
Mailing Address - Phone:850-884-1100
Mailing Address - Fax:
Practice Address - Street 1:BENNETT AVENUE
Practice Address - Street 2:BUILDING 90747
Practice Address - City:HURLBURT FIELD
Practice Address - State:FL
Practice Address - Zip Code:32548
Practice Address - Country:US
Practice Address - Phone:850-884-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-07
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
VA0110006807207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine