Provider Demographics
NPI:1962657452
Name:CULBERTSON, AMY J (FNP-BC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:J
Last Name:CULBERTSON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1719 GALE ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34223-6423
Mailing Address - Country:US
Mailing Address - Phone:615-330-9835
Mailing Address - Fax:
Practice Address - Street 1:1719 GALE ST
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34223
Practice Address - Country:US
Practice Address - Phone:615-330-9835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-25
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1025089363LF0000X
TN7493363LF0000X
FLARNP9471417363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily