Provider Demographics
NPI:1700913472
Name:TAYLOR, AMANDA R (PA-C)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:R
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:R
Other - Last Name:CLAUSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:5191 FIRST COAST TECH PKWY
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-0609
Mailing Address - Country:US
Mailing Address - Phone:904-223-3321
Mailing Address - Fax:904-223-2169
Practice Address - Street 1:2349 VILLAGE SQUARE PKWY STE 107
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-4319
Practice Address - Country:US
Practice Address - Phone:904-223-3321
Practice Address - Fax:904-223-2169
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA1020363A00000X
FLPA9112944363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000514238OtherANTHEM- CMA- CHILDREN'S ORTHPAEDICS OF LOUISVILLE
KY710001496OtherMEDICAID KY- CHILDREN'S ORTHOPAEDICS OF LOUISVILLE
KY2847841000OtherPASSPORT ADVANTAGE- CHILDREN'S ORTHOPAEDICS OF LOUISVILLE
KY000051983DOtherHUMANA- NORTON CHILDREN'S ORTHOPAEDICS OF LOUISVILLE
KY7985259OtherCIGNA- NORTON CHILDREN'S ORTHOPAEDICS OF LOUISVILLE
KY50015087OtherPASSPORT- CHILDREN'S ORTHOPAEDICS OF LOUISVILLE
KY611276316-046OtherTRICARE- CHILDREN'S ORTHOPAEDICS OF LOUISVILLE
KY2847841000OtherPASSPORT ADVANTAGE- CHILDREN'S ORTHOPAEDICS OF LOUISVILLE