MEDICARE: AMANDA CONNERTON APRN-CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	11039007	FL

General Provider Information

NPI Number	:	1033904065
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA CONNERTON APRN-CNP

Provider Business Mailing Address
First Line	:	11701 LAKE VICTORIA GARDENS AVE STE 3108
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-2705
Country	:	US
Telephone Number	:	203-278-0473
Fax Number	:

Provider Business Practice Location Address
First Line	:	11701 LAKE VICTORIA GARDENS AVE STE 3108
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-2705
Country	:	US
Telephone Number	:	203-278-0473
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2025
Last Update Date	:	10/13/2025

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