Healthcare Provider Details

I. General information

NPI: 1225436488
Provider Name (Legal Business Name): AMANDA MCCANN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2014
Last Update Date: 08/28/2023
Certification Date: 08/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1751 VETERANS DR STE 200
FLORENCE AL
35630-4930
US

IV. Provider business mailing address

1751 VETERANS DR STE 200
FLORENCE AL
35630-4930
US

V. Phone/Fax

Practice location:
  • Phone: 256-766-2118
  • Fax:
Mailing address:
  • Phone: 256-766-2118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1-108684
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-108684
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: