Provider Demographics
NPI:1376314401
Name:SWAN, AMY (AGNP-C)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:SWAN
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 SW 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:FL
Mailing Address - Zip Code:32693-4201
Mailing Address - Country:US
Mailing Address - Phone:352-221-0452
Mailing Address - Fax:
Practice Address - Street 1:1113 NW 23RD AVE
Practice Address - Street 2:
Practice Address - City:CHIEFLAND
Practice Address - State:FL
Practice Address - Zip Code:32626-1911
Practice Address - Country:US
Practice Address - Phone:352-493-9500
Practice Address - Fax:866-895-8359
Is Sole Proprietor?:No
Enumeration Date:2024-01-09
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9294106163W00000X
FL11030543363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11030543OtherAPRN