MEDICARE: MRS. JOAN MARIE AMSHEL PA-C,MHS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AS0400X	Surgical Physician Assistant	2617	AZ
2	363AS0400X	Surgical Physician Assistant	PA 9104494	FL

General Provider Information

NPI Number	:	1396038444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JOAN MARIE AMSHEL PA-C,MHS

Provider Business Mailing Address
First Line	:	725 EAGLE LN
Second Line	:
City	:	APOLLO BEACH
State	:	FL
Zip	:	33572-2718
Country	:	US
Telephone Number	:	813-641-9787
Fax Number	:	813-633-0082

Provider Business Practice Location Address
First Line	:	1046 CYPRESS VILLAGE BLVD
Second Line	:
City	:	RUSKIN
State	:	FL
Zip	:	33573-6845
Country	:	US
Telephone Number	:	813-633-0081
Fax Number	:	813-633-0082

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2011
Last Update Date	:	02/25/2020

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