Provider Demographics
NPI:1467260307
Name:DUGGAN, AMANDA TRACEY (PMHNP)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:TRACEY
Last Name:DUGGAN
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24972 AVENIDA VERANEO
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-2226
Mailing Address - Country:US
Mailing Address - Phone:949-285-9169
Mailing Address - Fax:
Practice Address - Street 1:24972 AVENIDA VERANEO
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-2226
Practice Address - Country:US
Practice Address - Phone:949-285-9169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-24
Last Update Date:2024-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9503348363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health