Provider Demographics
NPI:1720056948
Name:ATKINSON, AMY J (PA-C)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:J
Last Name:ATKINSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:MCCLARY
Other - Last Name:LAUER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:70 MARLBOROUGH RD
Mailing Address - Street 2:
Mailing Address - City:SHALIMAR
Mailing Address - State:FL
Mailing Address - Zip Code:32579-1036
Mailing Address - Country:US
Mailing Address - Phone:513-300-7553
Mailing Address - Fax:
Practice Address - Street 1:1131 S ORANGE AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1226
Practice Address - Country:US
Practice Address - Phone:941-444-0011
Practice Address - Fax:603-952-3900
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50001579RX363A00000X
FLPA9115819363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0333118Medicaid
OHLAPA22063Medicare PIN
OHLAPA22062Medicare PIN
OHLAPA22064Medicare PIN