Provider Demographics
NPI:1194260018
Name:MONTANARO, AMY LYNN (AGNP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LYNN
Last Name:MONTANARO
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:LYNN
Other - Last Name:HAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:347 SW PANTHER TRCE
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-8204
Mailing Address - Country:US
Mailing Address - Phone:919-433-6230
Mailing Address - Fax:
Practice Address - Street 1:11380 SW VILLAGE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34987-2389
Practice Address - Country:US
Practice Address - Phone:772-301-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-02
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9474990363LA2200X
NC5009135363LA2200X
FL9474990363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health