Provider Demographics
NPI:1912185323
Name:SIMS, AMANDA DEAN (LMT)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:DEAN
Last Name:SIMS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 A ST
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32404-3030
Mailing Address - Country:US
Mailing Address - Phone:850-276-3108
Mailing Address - Fax:
Practice Address - Street 1:2001 WILSON AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4532
Practice Address - Country:US
Practice Address - Phone:850-276-3108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA45785174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist