Provider Demographics
NPI:1902556053
Name:SHOEMAKER, AMANDA LEE
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEE
Last Name:SHOEMAKER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7207 GOLDEN WINGS RD STE 100
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-3324
Mailing Address - Country:US
Mailing Address - Phone:904-389-1010
Mailing Address - Fax:904-389-1082
Practice Address - Street 1:7207 GOLDEN WINGS RD STE 100
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-3324
Practice Address - Country:US
Practice Address - Phone:904-389-1010
Practice Address - Fax:904-389-1082
Is Sole Proprietor?:No
Enumeration Date:2022-03-23
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-13127363A00000X
FLPA9116456363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant