NPIMap

Individual provider Active NPI

Amanda Jacques, FNP

  • Nurse Practitioner
  • Tawas City, MI
National Provider Identifier
1376082487
Registry record updated Sep 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
4704276177 Issued in MI
Practice address
295 Maple St Ste 202
Tawas City, MI 48763-9352
Phone
(989) 362-6108
Fax
(989) 362-0161
NPI assigned
Feb 22, 2017
Last updated
Sep 12, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 12, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 4704276177 MI Primary

Addresses

Primary practice location

295 Maple St Ste 202
Tawas City, MI 48763-9352

Mailing address

4000 Wellness Dr
Midland, MI 48670-2000
Phone (844) 832-1956

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address amandajacques@smomsjhs.allscriptsdirect.net

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170427001647 MI Practitioner - Nurse Practitioner 5799062824 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mymichigan Medical Center TawasGroup PAC ID 9638070766, 36 clinicians

Practice addresses (Care Compare)

295 Maple St
Suite 202
Tawas City, MI 48763-9352
Phone (989) 362-6108

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
4704276177MIMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mymichigan Medical Center Tawas Current Accepting new patients
Mymichigan Medical Center Tawas CurrentSince Mar 25, 2017 Accepting new patients
Mymichigan Medical Center Tawas Past Accepting new patients
Mymichigan Medical Center Tawas Past Accepting new patients

Locations

3210 E Huron Rd
Au Gres, MI 48703
Phone (989) 876-6080

4000 Wellness Dr
Midland, MI 48670
Phone (844) 832-1956

5939 N Huron Rd
Oscoda, MI 48750
Phone (989) 739-1147

200 Hemlock Rd
Tawas City, MI 48763
Phone (989) 362-3411

295 Maple St
Ste 202
Tawas City, MI 48763
Phone (989) 362-6108

Interoperability endpoints

  • Direct secure messaging: amanda.jacques.1@11016.direct.athenahealth.com

Organizations & group practices 4

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

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1487721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757635200000",
    "number": "1376082487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4000 WELLNESS DR",
            "city": "MIDLAND",
            "state": "MI",
            "postal_code": "486702000",
            "telephone_number": "844-832-1956",
            "fax_number": "989-633-5241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "295 MAPLE ST STE 202",
            "city": "TAWAS CITY",
            "state": "MI",
            "postal_code": "487639352",
            "telephone_number": "989-362-6108",
            "fax_number": "989-362-0161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACQUES",
        "first_name": "AMANDA",
        "name_prefix": "Mrs.",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-02-22",
        "last_updated": "2025-09-12",
        "certification_date": "2025-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "4704276177",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "amandajacques@smomsjhs.allscriptsdirect.net",
            "affiliation": "N",
            "address_1": "295 Maple St Ste 202",
            "city": "Tawas City",
            "state": "MI",
            "country_code": "US",
            "postal_code": "487639352",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Tawas City, MI

Sources for this page

Verify at the official NPI Registry.