Healthcare Provider Details

I. General information

NPI: 1871199547
Provider Name (Legal Business Name): AMANDA NICOLE HARRIS FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2020
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 BRYANT ST STE 1A
SAN FRANCISCO CA
94107-1217
US

IV. Provider business mailing address

550 BRYANT ST STE 1A
SAN FRANCISCO CA
94107-1217
US

V. Phone/Fax

Practice location:
  • Phone: 415-513-1222
  • Fax: 415-777-1087
Mailing address:
  • Phone: 415-513-1222
  • Fax: 415-777-1087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number95015977
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2026028228
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95015977
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: