Healthcare Provider Details

I. General information

NPI: 1467721399
Provider Name (Legal Business Name): AMANDA ANSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2011
Last Update Date: 01/05/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2339 SW MARTIN HWY
PALM CITY FL
34990-3222
US

IV. Provider business mailing address

2339 SW MARTIN HWY
PALM CITY FL
34990-3222
US

V. Phone/Fax

Practice location:
  • Phone: 772-222-5302
  • Fax: 772-210-0986
Mailing address:
  • Phone: 772-222-5302
  • Fax: 772-210-0986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9118128
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1613
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: