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General NPI Number Information
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NPI Number | 1104485291
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Entity Type | Individual
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Provider Name | AMANDA NAUMANN PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/11/2019
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Last Update Date | 01/08/2026
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Provider Practice Location Address
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Address Line | 430 3RD AVE S APT 345
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City | ST PETERSBURG
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State | FL
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Zip | 33701-4248
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Country | US
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Telephone | 603-978-4464
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Fax |
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Provider Business Mailing Address
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Address Line | 430 3RD AVE S APT 345
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City | ST PETERSBURG
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State | FL
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Zip | 33701-4248
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Country | US
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Telephone | 603-978-4464
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 085011977
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 9112223
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License Number State | FL
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