Provider Demographics
NPI:1114731122
Name:GERACE, AMANDA C (ARNP)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:C
Last Name:GERACE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2407 PARKWOOD DR SE
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-2834
Mailing Address - Country:US
Mailing Address - Phone:757-751-2026
Mailing Address - Fax:
Practice Address - Street 1:2407 PARKWOOD DR SE
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-2834
Practice Address - Country:US
Practice Address - Phone:757-751-2026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61658113363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily