Provider Demographics
NPI:1154587335
Name:DALE, AMANDA A (NP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:A
Last Name:DALE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 SPRING CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37411-4922
Mailing Address - Country:US
Mailing Address - Phone:423-855-6868
Mailing Address - Fax:423-855-6896
Practice Address - Street 1:403 SPRING CREEK RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37411-4922
Practice Address - Country:US
Practice Address - Phone:423-855-6868
Practice Address - Fax:423-855-6896
Is Sole Proprietor?:No
Enumeration Date:2008-08-06
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN188679363LP2300X
TN13666363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care