Provider Demographics
NPI:1063815280
Name:MAXWELL, AMY JANE (FNP)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:JANE
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 18344
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33679-8344
Mailing Address - Country:US
Mailing Address - Phone:813-874-5500
Mailing Address - Fax:813-874-5505
Practice Address - Street 1:2605 W SWANN AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4039
Practice Address - Country:US
Practice Address - Phone:813-874-5500
Practice Address - Fax:813-874-5505
Is Sole Proprietor?:No
Enumeration Date:2014-10-01
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2678412363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014383200Medicaid