Provider Demographics
NPI:1659118693
Name:SHORTRIDGE, AMANDA NICOLE (FNP-C)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:NICOLE
Last Name:SHORTRIDGE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10039 REEDY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:VA
Mailing Address - Zip Code:24202-2921
Mailing Address - Country:US
Mailing Address - Phone:423-963-8832
Mailing Address - Fax:276-206-2228
Practice Address - Street 1:418 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-3408
Practice Address - Country:US
Practice Address - Phone:423-963-8832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024190694363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily