Provider Demographics
NPI:1396161519
Name:O'LOUGHLIN, AMANDA JEANNE
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:JEANNE
Last Name:O'LOUGHLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 N UNIVERSITY DR
Mailing Address - Street 2:STE #400
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-6089
Mailing Address - Country:US
Mailing Address - Phone:954-752-3166
Mailing Address - Fax:954-753-5628
Practice Address - Street 1:1725 N UNIVERSITY DR
Practice Address - Street 2:STE #400
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-6089
Practice Address - Country:US
Practice Address - Phone:954-752-3166
Practice Address - Fax:954-753-5628
Is Sole Proprietor?:No
Enumeration Date:2014-03-12
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103889363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical