Provider Demographics
NPI:1225030489
Name:HODGE, AMANDA RAMOS (MSN, APN, CPNP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:RAMOS
Last Name:HODGE
Suffix:
Gender:F
Credentials:MSN, APN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1301 BARBARA JORDAN BLVD
Mailing Address - Street 2:#302
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-3077
Mailing Address - Country:US
Mailing Address - Phone:512-472-6134
Mailing Address - Fax:512-472-2928
Practice Address - Street 1:1301 BARBARA JORDAN BLVD
Practice Address - Street 2:#302
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-3077
Practice Address - Country:US
Practice Address - Phone:512-472-6134
Practice Address - Fax:512-472-2928
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX563998363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP07413Medicare UPIN
TX85N004Medicare ID - Type Unspecified