Amplaa Behavioral Health

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

AMPLAA BEHAVIORAL HEALTH

Practice address

1895 Kingsley Ave Ste 403
Orange Park, FL 32073-4453

Phone

(904) 300-4341

NPI assigned

Sep 7, 2021

Last updated

Sep 8, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Gerry Lee SurrencyNPI 1457771016

Title

Owner

Phone

(904) 300-4341

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Gerry Surrency, PMHNP-BC, ARNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Orange Park, FL
  • NPI 1457771016
  Authorized official Same address or phone

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

{
    "created_epoch": "1630972800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631059200000",
    "number": "1639848450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1895 KINGSLEY AVE STE 403",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320734453",
            "telephone_number": "904-300-4341"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1895 KINGSLEY AVE STE 403",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320734453",
            "telephone_number": "904-300-4341"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMPLAA BEHAVIORAL HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-07",
        "last_updated": "2021-09-08",
        "certification_date": "2021-09-08",
        "status": "A",
        "authorized_official_last_name": "SURRENCY",
        "authorized_official_first_name": "GERRY",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-300-4341",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• American Dental Care of Jacksonville, Inc.
• American Dental Wellness PA
• Christina Ametrano
• Mohamed Amin
• Katrina Marie Ammons, PTA
• Derian Anderson
• Jessica Anderson
• Lenoir Anderson
• Wilandria Anderson
• Noah Andone, DDS

• Psychiatric/Mental Health Nurse Practitioner in Orange Park, FL
• Providers in Orange Park, FL by specialty
• Psychiatric/Mental Health Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.