Provider Demographics
NPI:1316913239
Name:HANKS, AMANDA CARLENE LUCERO (APRN)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:CARLENE LUCERO
Last Name:HANKS
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 W CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-3104
Mailing Address - Country:US
Mailing Address - Phone:863-658-1764
Mailing Address - Fax:855-847-7646
Practice Address - Street 1:131 W CENTER AVE
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870
Practice Address - Country:US
Practice Address - Phone:863-658-1764
Practice Address - Fax:855-847-7646
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2980082363LA2200X
FLARNP2980082363LF0000X
FLAPRN2980082363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL307168500Medicaid
DC307168500Medicaid
FL307168500Medicaid
FLQ61011Medicare UPIN
FLU6704ZMedicare PIN