Provider Demographics
NPI:1821398579
Name:COLE, AMBER BRITTANY (PA-C)
Entity type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:BRITTANY
Last Name:COLE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:AMBER
Other - Middle Name:BRITTANY
Other - Last Name:MANACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:12329 WATERSTONE LN
Mailing Address - Street 2:APT 618
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-3051
Mailing Address - Country:US
Mailing Address - Phone:412-691-1116
Mailing Address - Fax:
Practice Address - Street 1:4405 N HOLLAND SYLVANIA RD
Practice Address - Street 2:SUITE 101
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-3529
Practice Address - Country:US
Practice Address - Phone:419-517-0146
Practice Address - Fax:419-517-0496
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-28
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA054681363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical