Provider Demographics
NPI:1952386724
Name:ISLEY, AMBER LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:AMBER
Middle Name:LYNN
Last Name:ISLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 RIVERPLACE BLVD
Mailing Address - Street 2:SUITE 620
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-9046
Mailing Address - Country:US
Mailing Address - Phone:904-396-6620
Mailing Address - Fax:904-396-6528
Practice Address - Street 1:1200 RIVERPLACE BLVD
Practice Address - Street 2:SUITE 620
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-9046
Practice Address - Country:US
Practice Address - Phone:904-396-6620
Practice Address - Fax:904-396-6528
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0081223207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL200651OtherHEALTHEASE
FL2145544OtherUNITED HEALTH CARE
FL58998OtherBCBS PPC
FL261631900Medicaid
FL500029596OtherRR MEDICARE
FL58998ZMedicare PIN
FL58998XMedicare ID - Type UnspecifiedGROUP 99262B
FL200651OtherHEALTHEASE
FL58998YMedicare ID - Type UnspecifiedGROUP 99262