Provider Demographics
NPI:1801428669
Name:HAIR, AMANDA LYNN (APRN)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:LYNN
Last Name:HAIR
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1765 DAVID WALKER DR
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-5745
Mailing Address - Country:US
Mailing Address - Phone:352-343-3330
Mailing Address - Fax:352-742-0354
Practice Address - Street 1:1765 DAVID WALKER DR
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-5745
Practice Address - Country:US
Practice Address - Phone:352-343-3330
Practice Address - Fax:352-742-0354
Is Sole Proprietor?:No
Enumeration Date:2020-02-10
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLAPRN11006095363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics