Provider Demographics
NPI:1215437405
Name:SAPP, AMANDA JOHNSON (NP-C)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:JOHNSON
Last Name:SAPP
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 MOSLEY DR
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-5625
Mailing Address - Country:US
Mailing Address - Phone:850-784-7722
Mailing Address - Fax:
Practice Address - Street 1:1303 MOSLEY DR
Practice Address - Street 2:
Practice Address - City:LYNN HAVEN
Practice Address - State:FL
Practice Address - Zip Code:32444-5625
Practice Address - Country:US
Practice Address - Phone:850-784-7722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-14
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9294976163W00000X, 363LF0000X
GA237474363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse