Provider Demographics
NPI:1225649817
Name:RODRIGUEZ, AMANDA BAYNARD (AGPCNP-BC)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:BAYNARD
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:BAYNARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AGPCNP-BC
Mailing Address - Street 1:3001 LAKE BROOK BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-3761
Mailing Address - Country:US
Mailing Address - Phone:865-374-0500
Mailing Address - Fax:
Practice Address - Street 1:3001 LAKE BROOK BLVD STE 101
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-3761
Practice Address - Country:US
Practice Address - Phone:865-374-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-16
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24269363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP7155Medicaid
TNQ080166Medicaid
SCSCI9047628OtherMEDICARE PIN