Provider Demographics
NPI:1356912091
Name:MACKOWSKI, AMANDA JORDAN (APRN AGACNP-BC CCRN)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:JORDAN
Last Name:MACKOWSKI
Suffix:
Gender:F
Credentials:APRN AGACNP-BC CCRN
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:LEIGH
Other - Last Name:JORDAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20207 CHASEWOOD PARK DR STE 305
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-1442
Mailing Address - Country:US
Mailing Address - Phone:281-444-3278
Mailing Address - Fax:
Practice Address - Street 1:17350 ST LUKES WAY STE 400
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77384-4167
Practice Address - Country:US
Practice Address - Phone:936-266-4847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-04
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1045615363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care