Provider Demographics
NPI:1285202010
Name:MASCOE, AMANDA LYNNE (APRN)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LYNNE
Last Name:MASCOE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:LYNNE
Other - Last Name:RILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:18316 MURDOCK CIR UNIT 108
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33948-1029
Mailing Address - Country:US
Mailing Address - Phone:941-629-3500
Mailing Address - Fax:
Practice Address - Street 1:2639 CURRY LN
Practice Address - Street 2:
Practice Address - City:NOKOMIS
Practice Address - State:FL
Practice Address - Zip Code:34275-4903
Practice Address - Country:US
Practice Address - Phone:941-244-5089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-17
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11013715363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily