Basic Information
| Provider Information | |||||||||
| NPI: | 1376761486 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WHISNANT | ||||||||
| FirstName: | AMANDA | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2429 | ||||||||
| Address2: | |||||||||
| City: | COPPELL | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750198429 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9724201475 | ||||||||
| FaxNumber: | 4696715437 | ||||||||
| Practice Location | |||||||||
| Address1: | 4570 LYONS RD STE 110 | ||||||||
| Address2: | |||||||||
| City: | COCONUT CREEK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330733481 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9549713210 | ||||||||
| FaxNumber: | 9549713427 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2007 | ||||||||
| LastUpdateDate: | 10/30/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 2674 | SC | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LP0200X | APRN9272409 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 100564800 | 05 | FL | MEDICAID |