MEDICARE: MARIE MICHELLE AMANZE MD

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	207RH0003X	Hematology & Oncology Physician	ME94463	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	30319	OTHER	FL	FLORIDA BLUE

General Provider Information

NPI Number	:	1740383181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIE MICHELLE AMANZE MD

Provider Business Mailing Address
First Line	:	1309 THOMASWOOD DR
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308-7915
Country	:	US
Telephone Number	:	850-727-8540
Fax Number	:	850-765-8674

Provider Business Practice Location Address
First Line	:	1309 THOMASWOOD DR
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308-7915
Country	:	US
Telephone Number	:	850-727-8540
Fax Number	:	850-765-8674

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

Provider Enumeration Date	:	09/07/2006
Last Update Date	:	07/02/2015

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