Provider Demographics
NPI:1063966406
Name:JAMIESON, AMANDA (FNP)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:
Last Name:JAMIESON
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 1:1009 CAMELOT DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-7525
Mailing Address - Country:US
Mailing Address - Phone:302-293-2817
Mailing Address - Fax:
Practice Address - Street 1:100 S MAIN ST
Practice Address - Street 2:SUITE NUMBER 205
Practice Address - City:SMYRNA
Practice Address - State:DE
Practice Address - Zip Code:19977-1477
Practice Address - Country:US
Practice Address - Phone:302-653-6022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-14
Last Update Date:2016-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG-0000953363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily