Provider Demographics
NPI:1922037571
Name:HUBER, AMY C (PA)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:C
Last Name:HUBER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:C
Other - Last Name:PISCITELLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:11505 RANGELAND PKWY
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34211-4041
Mailing Address - Country:US
Mailing Address - Phone:941-907-6016
Mailing Address - Fax:941-907-0199
Practice Address - Street 1:11505 RANGELAND PKWY
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34211-4041
Practice Address - Country:US
Practice Address - Phone:941-907-6016
Practice Address - Fax:941-907-0199
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103707363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY00WXOtherFLORIDA BLUE
FL292463300Medicaid
FLY00WXOtherFLORIDA BLUE