Provider Demographics
NPI:1053368035
Name:AMATO, RICHARD J (PA-C)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:J
Last Name:AMATO
Suffix:
Gender:M
Credentials:PA-C
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4205 BELFORT RD STE 4015
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-3623
Mailing Address - Country:US
Mailing Address - Phone:904-450-6063
Mailing Address - Fax:904-539-4091
Practice Address - Street 1:5147 N 9TH AVE
Practice Address - Street 2:STE 318
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504
Practice Address - Country:US
Practice Address - Phone:850-462-2250
Practice Address - Fax:850-741-3053
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9104987363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02591711Medicaid
NYP67048Medicare UPIN
NYPA0544Medicare ID - Type UnspecifiedUPSTATE