Provider Demographics
NPI:1356716104
Name:LABIGANG, AMANDA LYNN (ARNP)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:LYNN
Last Name:LABIGANG
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 NW LAKE WHITNEY PL
Mailing Address - Street 2:SUITE 106
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-1615
Mailing Address - Country:US
Mailing Address - Phone:772-785-8000
Mailing Address - Fax:
Practice Address - Street 1:501 NW LAKE WHITNEY PL
Practice Address - Street 2:SUITE 106
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-1615
Practice Address - Country:US
Practice Address - Phone:772-785-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-04
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN 9271635390200000X
FLARNP9271635363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program