MEDICARE: MRS. AMANDA IRENE THORNGREN MSN, FNP

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	APRN11027946	FL

General Provider Information

NPI Number	:	1659141943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMANDA IRENE THORNGREN MSN, FNP

Provider Business Mailing Address
First Line	:	8537 RIVERSIDE DR NE
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33702-3750
Country	:	US
Telephone Number	:	815-501-8073
Fax Number	:

Provider Business Practice Location Address
First Line	:	508 S HABANA AVE STE 210
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-4161
Country	:	US
Telephone Number	:	813-873-9010
Fax Number	:

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

Provider Enumeration Date	:	01/08/2024
Last Update Date	:	01/08/2024

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