Provider Demographics
NPI:1083592141
Name:GEORGIOPOULOS, AMANDA LYNN (NP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LYNN
Last Name:GEORGIOPOULOS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 GREEN TREE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-4758
Mailing Address - Country:US
Mailing Address - Phone:646-831-4381
Mailing Address - Fax:
Practice Address - Street 1:39 GREEN TREE DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-4758
Practice Address - Country:US
Practice Address - Phone:646-831-4381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF353585-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty