Provider Demographics
NPI:1265220610
Name:SMITH, AMANDA GAIL (APRN)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:GAIL
Last Name:SMITH
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2982 CHIEF RIDAUGHT TRL
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:FL
Mailing Address - Zip Code:32068-4249
Mailing Address - Country:US
Mailing Address - Phone:904-209-3960
Mailing Address - Fax:
Practice Address - Street 1:2982 CHIEF RIDAUGHT TRL
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG
Practice Address - State:FL
Practice Address - Zip Code:32068-4249
Practice Address - Country:US
Practice Address - Phone:904-209-3960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11039119363LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine