Healthcare Provider Details

I. General information

NPI: 1275160731
Provider Name (Legal Business Name): AMANDA CRAVEN GAGE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA NICOLE CRAVEN

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 08/29/2023
Certification Date: 08/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 OAKFIELD DR
BRANDON FL
33511-5779
US

IV. Provider business mailing address

601 E ALTAMONTE DR
ALTAMONTE SPRINGS FL
32701-4802
US

V. Phone/Fax

Practice location:
  • Phone: 813-916-2347
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number19932
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: