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NPI Code Detail

MEDICARE: AMANDA JON MCNALLY YATABE APRN

MEDICARE: AMANDA JON MCNALLY YATABE APRN
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
1101YM0800XMental Health CounselorAPRN11011170FL
2363L00000XNurse Practitioner11011170FL
3363LF0000XFamily Nurse PractitionerAPRN11011170FL

General Provider Information

NPI Number : 1316537756
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA JON MCNALLY YATABE APRN
Provider Business Mailing Address
First Line : 755 RINEHART RD STE 100
Second Line :
City : LAKE MARY
State : FL
Zip : 32746-4885
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 755 RINEHART RD STE 100
Second Line :
City : LAKE MARY
State : FL
Zip : 32746-4885
Country : US
Telephone Number : 407-875-3700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/20/2021
Last Update Date : 08/25/2025

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