Amber Nicole Dean, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

9104174 Issued in FL

Practice address

836 Prudential Dr
Suite 1103
Jacksonville, FL 32207-8334

Phone

(904) 398-9499

Fax

(904) 398-0118

NPI assigned

Jun 28, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Dalton Dermatology & Day Spa, LLC

  • Dermatology Physician
  • Dalton, GA
  • NPI 1033557160
  Medicare reassignment
• Baptist Cardiology, Inc.

  • Cardiovascular Disease Physician
  • Jacksonville, FL
  • NPI 1790743854
  NPD (past)
• North Florida Obstetrical and Gynecological Associates PA

  • Obstetrics & Gynecology Physician
  • Jacksonville, FL
  • NPI 1316907926
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1182988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1355788800000",
    "number": "1265639785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 16568",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322456568",
            "telephone_number": "904-472-2300",
            "fax_number": "904-472-2330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "836 PRUDENTIAL DR",
            "address_2": "SUITE 1103",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322078334",
            "telephone_number": "904-398-9499",
            "fax_number": "904-398-0118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEAN",
        "first_name": "AMBER",
        "middle_name": "NICOLE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-28",
        "last_updated": "2012-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "9104174",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "9104174",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• De Urgent Care Jax PA
• De2 LLC
• Nyla Deadwiler
• Latisha R Deal
• Angela Deallie
• Anthony T Dean, DDS
• Charles Dean III, LMHC
• Cynthia Dean, BA
• Jacqueline C Dean, RN
• Julius Dean, MD

• Physician Assistant in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.