Provider Demographics
NPI:1528681525
Name:MOTA, AMNA (PA-C)
Entity type:Individual
Prefix:
First Name:AMNA
Middle Name:
Last Name:MOTA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14690 SPRING HILL DR
Mailing Address - Street 2:STE 305
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-8102
Mailing Address - Country:US
Mailing Address - Phone:352-277-5348
Mailing Address - Fax:352-606-2857
Practice Address - Street 1:6520 N PRESIDENT GEORGE BUSH HWY STE 100
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75044-3925
Practice Address - Country:US
Practice Address - Phone:210-281-8669
Practice Address - Fax:210-314-5044
Is Sole Proprietor?:No
Enumeration Date:2020-05-26
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9113158363A00000X
TXPA15212363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108169600Medicaid
TXPA15212Medicaid