Amanda Gray Connan, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9106972 Issued in FL

Practice address

8725 N Wickham Rd
Suite 302
Melbourne, FL 32940-2239

Phone

(321) 434-9230

Fax

(321) 434-9231

NPI assigned

Aug 27, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

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.

• Surgical Assistants of America, Inc.

  • Surgery Physician
  • Duluth, GA
  • NPI 1417977885

  Surgical

  NPD (past)

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

{
    "created_epoch": "1188172800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1354147200000",
    "number": "1851584593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 561600",
            "city": "ROCKLEDGE",
            "state": "FL",
            "postal_code": "329561600",
            "telephone_number": "321-434-4600",
            "fax_number": "321-259-0635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8725 N WICKHAM RD",
            "address_2": "SUITE 302",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329402239",
            "telephone_number": "321-434-9230",
            "fax_number": "321-434-9231"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONNAN",
        "first_name": "AMANDA",
        "middle_name": "GRAY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-27",
        "last_updated": "2012-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "GA",
            "license": "005133",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9106972",
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "FL",
            "license": "PA9106972",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Arianna Concepcion Rainoldi
• Ana Marisol Conde-Rosa, MD
• Remi Conley
• Marianne Conlin, MA, SLP-CCC
• Jenna Conn
• Alexa Marie Connors, PA-C
• Kyle S Conrad
• Deborah L Consbruck, O.D.
• Leonora Lillian Conte, MSN, ANP-BC
• Melissa Michelle Conti, OTR

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2012; 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.