IndividualActive
Amanda Licea, PA-C
NPI 1609110683 · Medical Physician Assistant · Austin, TX
Provider details
- NPI number
- 1609110683
- Entity type
- Individual
- Primary specialty
- Medical Physician AssistantPhysician Assistants & Advanced Practice Nursing Providers
- Credential
- PA-C
- Sex
- Female
- Sole proprietor
- No
- License
- PA08169 (TX)
Practice location
608 Radam Ln
Austin, TX 78745-1172
Phone: (512) 443-5988
Fax: (512) 443-5055
Mailing address
8240 N Mopac Expy Ste 100
Austin, TX 78759-8869
Registry dates
- Enumerated
- 2012-11-15
- Last updated
- 2021-09-22
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.