Healthcare Provider Details

I. General information

NPI: 1508832668
Provider Name (Legal Business Name): AMY L. WHITE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1285 CREEKSIDE BLVD E UNIT 102
NAPLES FL
34109-0595
US

IV. Provider business mailing address

1285 CREEKSIDE BLVD E UNIT 102
NAPLES FL
34109-0595
US

V. Phone/Fax

Practice location:
  • Phone: 239-624-0310
  • Fax: 239-624-0311
Mailing address:
  • Phone: 239-624-0310
  • Fax: 239-624-0311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0003595
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9110268
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: