Provider Demographics
NPI:1649361197
Name:MUSSELMAN, AMANDA J (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:J
Last Name:MUSSELMAN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:JEAN
Other - Last Name:EARNEST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:HEALTH SERVICE TECH
Mailing Address - Street 1:1700 S 23RD ST
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4803
Mailing Address - Country:US
Mailing Address - Phone:772-468-4551
Mailing Address - Fax:
Practice Address - Street 1:1700 S 23RD ST
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4803
Practice Address - Country:US
Practice Address - Phone:772-468-4551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9309351163WE0003X
247200000X
FLAPRN11027973363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other