Provider Demographics
NPI:1427326206
Name:GARGANO, AMANDA L (CNP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:L
Last Name:GARGANO
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:LEE
Other - Last Name:LAWRENCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:317-396-1300
Mailing Address - Fax:317-962-4343
Practice Address - Street 1:11725 N ILLINOIS ST STE 545
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-3014
Practice Address - Country:US
Practice Address - Phone:317-688-5155
Practice Address - Fax:317-217-2233
Is Sole Proprietor?:No
Enumeration Date:2011-12-07
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71003790A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner