Healthcare Provider Details

I. General information

NPI: 1689780959
Provider Name (Legal Business Name): AMANDA KOWALSKI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 CATTLEMEN RD SUITE 106
SARASOTA FL
34232-6056
US

IV. Provider business mailing address

3333 CATTLEMEN RD SUITE 106
SARASOTA FL
34232-6056
US

V. Phone/Fax

Practice location:
  • Phone: 941-379-1799
  • Fax: 941-379-1899
Mailing address:
  • Phone: 941-379-1799
  • Fax: 941-379-1899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA 051508
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA 9103694
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: