Provider Demographics
NPI:1992697619
Name:CABAN, AMANDA MIGUEL (PA)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MIGUEL
Last Name:CABAN
Suffix:
Gender:F
Credentials:PA
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Other - Credentials:
Mailing Address - Street 1:PO BOX 748817
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-8817
Mailing Address - Country:US
Mailing Address - Phone:813-286-0033
Mailing Address - Fax:813-282-1806
Practice Address - Street 1:4321 N MACDILL AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6388
Practice Address - Country:US
Practice Address - Phone:813-961-7440
Practice Address - Fax:888-720-0905
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-17
Last Update Date:2025-09-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9120775363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant