Provider Demographics
NPI:1205696028
Name:MORGAN, AMANDA KAY (APRN)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:KAY
Last Name:MORGAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:789 W DUVAL ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32055-3811
Mailing Address - Country:US
Mailing Address - Phone:386-755-1546
Mailing Address - Fax:
Practice Address - Street 1:789 W DUVAL ST
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-3811
Practice Address - Country:US
Practice Address - Phone:386-755-1546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11031899363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics