Provider Demographics
NPI:1205868726
Name:CUMMISKEY, AMY LYNN (PA-C)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LYNN
Last Name:CUMMISKEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:LYNN
Other - Last Name:WALLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:615 E PRINCETON ST
Mailing Address - Street 2:SUITE 540
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-1456
Mailing Address - Country:US
Mailing Address - Phone:407-236-0006
Mailing Address - Fax:407-236-0007
Practice Address - Street 1:615 E PRINCETON ST
Practice Address - Street 2:SUITE 540
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1456
Practice Address - Country:US
Practice Address - Phone:407-236-0006
Practice Address - Fax:407-236-0007
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01022363A00000X, 363AS0400X
FLPA9106130363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX183945801Medicaid
FLY0A90OtherBCBS
OK200132820AOtherOKLAHOMA MEDICAID
TX8Y0707OtherBCBS
FL004318800Medicaid
TXR18969Medicare UPIN
TX183945801Medicaid
TX8J1805Medicare PIN