Provider Demographics
NPI:1104688209
Name:RATCLIFF, AMBER MICHELLE
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:MICHELLE
Last Name:RATCLIFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13461 MONTICELLO BLVD
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36527-0128
Mailing Address - Country:US
Mailing Address - Phone:919-920-9933
Mailing Address - Fax:
Practice Address - Street 1:55 SERVICE CENTER RD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-5942
Practice Address - Country:US
Practice Address - Phone:919-920-9933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-25
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-159392363LF0000X, 3416A0800X, 163WF0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No3416A0800XTransportation ServicesAmbulanceAir Transport
No163WF0300XNursing Service ProvidersRegistered NurseFlight