MEDICARE: JESSICA AMIGO MSN, PMHNP-BC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP70045141	WA
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	11042002	FL

General Provider Information

NPI Number	:	1548134604
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA AMIGO MSN, PMHNP-BC

Provider Business Mailing Address
First Line	:	6904 SW 127TH CT
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33183-2404
Country	:	US
Telephone Number	:	786-932-8830
Fax Number	:

Provider Business Practice Location Address
First Line	:	6904 SW 127TH CT
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33183-2404
Country	:	US
Telephone Number	:	786-932-8830
Fax Number	:

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

Provider Enumeration Date	:	10/01/2025
Last Update Date	:	03/05/2026

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