Healthcare Provider Details

I. General information

NPI: 1659377331
Provider Name (Legal Business Name): VANCE AMOS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 02/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 W NEWBERRY RD
GAINESVILLE FL
32607-2245
US

IV. Provider business mailing address

4500 W NEWBERRY RD
GAINESVILLE FL
32607-2245
US

V. Phone/Fax

Practice location:
  • Phone: 352-336-6000
  • Fax: 352-336-6085
Mailing address:
  • Phone: 352-336-6000
  • Fax: 352-332-0799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA3007
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: