Provider Demographics
NPI:1205149556
Name:PAINTER, AMY R (MSN, FNP-BC, AC-PNP)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:R
Last Name:PAINTER
Suffix:
Gender:F
Credentials:MSN, FNP-BC, AC-PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 E PRINCETON ST STE 225
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-1423
Mailing Address - Country:US
Mailing Address - Phone:407-303-9926
Mailing Address - Fax:407-303-9928
Practice Address - Street 1:615 E PRINCETON ST STE 225
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1423
Practice Address - Country:US
Practice Address - Phone:407-303-9926
Practice Address - Fax:407-303-9928
Is Sole Proprietor?:No
Enumeration Date:2010-07-15
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA194830363LF0000X
FL9335540363LF0000X
SC4277363LF0000X
FLARNP9335540363LP0222X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003133731AMedicaid
SCAA6505OtherMEDICARE ID
SCNP1753Medicaid