Provider Demographics
NPI:1902358393
Name:AMELUNG, TRICIA (FNP)
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:
Last Name:AMELUNG
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 N MAIN ST
Mailing Address - Street 2:STE 303
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29926-6614
Mailing Address - Country:US
Mailing Address - Phone:843-816-7266
Mailing Address - Fax:
Practice Address - Street 1:23 N MAIN ST
Practice Address - Street 2:STE 303
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-6614
Practice Address - Country:US
Practice Address - Phone:843-816-7266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-01
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20461363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care