Provider Demographics
NPI:1588688733
Name:KOLER, AMY JOAN (MD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:JOAN
Last Name:KOLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603-7TH ST SO
Mailing Address - Street 2:#500
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4734
Mailing Address - Country:US
Mailing Address - Phone:727-822-0442
Mailing Address - Fax:727-821-0416
Practice Address - Street 1:603-7TH ST SO
Practice Address - Street 2:#500
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4734
Practice Address - Country:US
Practice Address - Phone:727-822-0442
Practice Address - Fax:727-821-0416
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV12397208600000X
FLME104839208600000X, 2086S0127X, 2086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV12397OtherMEDICAL LICENSE
NVCS15369OtherPHARMACY LICENSE
NVCS15369OtherPHARMACY LICENSE
AZG94997Medicare UPIN