Provider Demographics
NPI:1144560442
Name:JENSEN, AMY (PA-C)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:
Last Name:JENSEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:222 BROADWAY UNIT 302
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-5767
Mailing Address - Country:US
Mailing Address - Phone:407-846-8180
Mailing Address - Fax:407-347-4858
Practice Address - Street 1:222 BROADWAY UNIT 301
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-5767
Practice Address - Country:US
Practice Address - Phone:407-846-8180
Practice Address - Fax:407-347-4858
Is Sole Proprietor?:No
Enumeration Date:2013-02-22
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9107910363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical