Provider Demographics
NPI:1922447291
Name:ELLIOTT, AMANDA J (PA-C)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:J
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13365 OVERSEAS HWY APT 201
Mailing Address - Street 2:
Mailing Address - City:MARATHON
Mailing Address - State:FL
Mailing Address - Zip Code:33050-3513
Mailing Address - Country:US
Mailing Address - Phone:715-491-7697
Mailing Address - Fax:305-296-2209
Practice Address - Street 1:925 TOPPINO DR
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040
Practice Address - Country:US
Practice Address - Phone:305-296-2212
Practice Address - Fax:305-296-2209
Is Sole Proprietor?:No
Enumeration Date:2013-06-20
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3087-23363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant