Provider Demographics
NPI:1952972390
Name:AMOS, BRYCE (APRN)
Entity Type:Individual
Prefix:
First Name:BRYCE
Middle Name:
Last Name:AMOS
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4164 W COUNTY HIGHWAY 30A
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32459-4336
Mailing Address - Country:US
Mailing Address - Phone:850-622-2313
Mailing Address - Fax:850-622-2718
Practice Address - Street 1:4164 W COUNTY HIGHWAY 30A
Practice Address - Street 2:
Practice Address - City:SANTA ROSA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32459-4336
Practice Address - Country:US
Practice Address - Phone:850-622-2313
Practice Address - Fax:850-622-2718
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-07
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11013874363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner