Provider Demographics
NPI:1528384922
Name:GENSER, AMANDA S (ARNP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:S
Last Name:GENSER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:S
Other - Last Name:JERRELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1037 S STATE ROAD 7
Mailing Address - Street 2:SUITE 211
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6138
Mailing Address - Country:US
Mailing Address - Phone:561-798-3030
Mailing Address - Fax:
Practice Address - Street 1:1037 S STATE ROAD 7
Practice Address - Street 2:SUITE 211
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6138
Practice Address - Country:US
Practice Address - Phone:561-798-3030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-12
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9278216363L00000X
CA794382363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner