Provider Demographics
NPI:1396502266
Name:STRUB, AMBER LEEANN (DNP, PMHNP, BSN-RN)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:LEEANN
Last Name:STRUB
Suffix:
Gender:F
Credentials:DNP, PMHNP, BSN-RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 VIEW POINTE LN
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30241-9103
Mailing Address - Country:US
Mailing Address - Phone:912-755-8153
Mailing Address - Fax:
Practice Address - Street 1:209 VIEW POINTE LN
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30241-9103
Practice Address - Country:US
Practice Address - Phone:912-755-8153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN186684363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty