Individual
AMANDA GIST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
125 E COPELAND DR, ORLANDO, FL 32806-2101
(321) 841-7090
(321) 843-2267
Mailing address
10507 CYPRESS TRAIL DR, ORLANDO, FL 32825-5038
(562) 508-6996
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA9117898
FL
Other
Enumeration date
09/21/2023
Last updated
12/05/2023
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