Provider Demographics
NPI:1861726010
Name:MALIN, AMANDA L (APN)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:L
Last Name:MALIN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:LINDSAY
Other - Last Name:RUIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3055 WATSON ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38118-3011
Mailing Address - Country:US
Mailing Address - Phone:901-369-4900
Mailing Address - Fax:901-365-3555
Practice Address - Street 1:848 ADAMS AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-2816
Practice Address - Country:US
Practice Address - Phone:901-287-6273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-21
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPNP14324363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics