Provider Demographics
NPI:1306339320
Name:RACKARD, AMY (NP-C)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:
Last Name:RACKARD
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MR
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:RACKARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1620 NEARING HILLS CIR
Mailing Address - Street 2:
Mailing Address - City:CHIPLEY
Mailing Address - State:FL
Mailing Address - Zip Code:32428-5938
Mailing Address - Country:US
Mailing Address - Phone:850-326-2694
Mailing Address - Fax:
Practice Address - Street 1:1620 NEARING HILLS CIR
Practice Address - Street 2:
Practice Address - City:CHIPLEY
Practice Address - State:FL
Practice Address - Zip Code:32428-5938
Practice Address - Country:US
Practice Address - Phone:850-326-2694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-13
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9328791363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily