Healthcare Provider Details

I. General information

NPI: 1720056948
Provider Name (Legal Business Name): AMY J ATKINSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY MCCLARY LAUER

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1131 S ORANGE AVE
ORLANDO FL
32806-1226
US

IV. Provider business mailing address

70 MARLBOROUGH RD
SHALIMAR FL
32579-1036
US

V. Phone/Fax

Practice location:
  • Phone: 941-444-0011
  • Fax: 603-952-3900
Mailing address:
  • Phone: 513-300-7553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50001579RX
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9115819
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: