Healthcare Provider Details

I. General information

NPI: 1437712346
Provider Name (Legal Business Name): AMANDA CATHERINE LANGE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2019
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7243 DELLA DR STE J
ORLANDO FL
32819-5106
US

IV. Provider business mailing address

303 E PAR ST
ORLANDO FL
32804-4003
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-2800
  • Fax: 321-843-3574
Mailing address:
  • Phone: 321-842-2299
  • Fax: 321-843-4101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9115029
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: