Basic Information
| Provider Information | |||||||||
| NPI: | 1891729067 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SAGER | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | CLARE | ||||||||
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| Credential: | NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1006 W PLEASANT ST | ||||||||
| Address2: | |||||||||
| City: | AVON PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338252966 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8634533121 | ||||||||
| FaxNumber: | 8634522823 | ||||||||
| Practice Location | |||||||||
| Address1: | 1006 W PLEASANT ST | ||||||||
| Address2: | |||||||||
| City: | AVON PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338252966 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8634533121 | ||||||||
| FaxNumber: | 8634522823 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2006 | ||||||||
| LastUpdateDate: | 04/22/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | APN0000005536 | TN | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | ARNP9267346 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 308728000 | 05 | FL | MEDICAID | 3342827 | 05 | TN | MEDICAID | P00329466 | 01 | RAILROAD MEDICARE | OTHER | 4140513 | 01 | TN | BCBS-TN | OTHER |