Provider Demographics
NPI:1649459736
Name:THOMPSON, AMANDA SHIANNE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:SHIANNE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:9961 E COUNTY HIGHWAY 30A
Mailing Address - Street 2:STE 5
Mailing Address - City:SEACREST
Mailing Address - State:FL
Mailing Address - Zip Code:32461-7282
Mailing Address - Country:US
Mailing Address - Phone:850-231-9286
Mailing Address - Fax:850-231-9287
Practice Address - Street 1:9961 E COUNTY HIGHWAY 30A
Practice Address - Street 2:STE 5
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32461-7282
Practice Address - Country:US
Practice Address - Phone:850-231-9286
Practice Address - Fax:850-231-9286
Is Sole Proprietor?:No
Enumeration Date:2007-10-25
Last Update Date:2016-09-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC001001125363AM0700X
FLPA9105932363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical