Provider Demographics
NPI:1407456882
Name:LINNEMAN, AMANDA N (AGACNP-BC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:N
Last Name:LINNEMAN
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:N
Other - Last Name:DESALVO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5410 MARYLAND WAY STE 400
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-8087
Mailing Address - Country:US
Mailing Address - Phone:651-461-2255
Mailing Address - Fax:215-463-3820
Practice Address - Street 1:5410 MARYLAND WAY STE 400
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-8087
Practice Address - Country:US
Practice Address - Phone:651-461-2255
Practice Address - Fax:215-463-3820
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP022730363LA2100X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care