Provider Demographics
NPI:1366429862
Name:BARTELL, AMANDA (DPM)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:
Last Name:BARTELL
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 TOWN PLAZA AVE STE A
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA
Mailing Address - State:FL
Mailing Address - Zip Code:32081-5164
Mailing Address - Country:US
Mailing Address - Phone:904-236-5023
Mailing Address - Fax:904-236-5073
Practice Address - Street 1:465 TOWN PLAZA AVE STE A
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA
Practice Address - State:FL
Practice Address - Zip Code:32081-5164
Practice Address - Country:US
Practice Address - Phone:904-236-5023
Practice Address - Fax:904-236-5073
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP03128213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL65838OtherBLUE CROSS BLUE SHIELD
FL2701421OtherUNITED HEALTHCARE
FL2701421OtherUNITED HEALTHCARE
FL65838OtherBLUE CROSS BLUE SHIELD
FLP00681611Medicare PIN