Provider Demographics
NPI:1912146374
Name:HANDLEY, AMANDA JILL (CRNA)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:JILL
Last Name:HANDLEY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6923
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32550-1006
Mailing Address - Country:US
Mailing Address - Phone:205-907-1265
Mailing Address - Fax:
Practice Address - Street 1:1225 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-2909
Practice Address - Country:US
Practice Address - Phone:850-650-7606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-09
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX898759367500000X
AL1-097084367500000X
FLAPRN11027698367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003534000Medicaid
FL003534000Medicaid