Healthcare Provider Details

I. General information

NPI: 1013770940
Provider Name (Legal Business Name): AMANDA JEAN PATEL FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2024
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 E ALTAMONTE DR STE 1500
ALTAMONTE SPRINGS FL
32701-4407
US

IV. Provider business mailing address

15 SAPPHIRE RD
OCALA FL
34472-2350
US

V. Phone/Fax

Practice location:
  • Phone: 689-240-1719
  • Fax:
Mailing address:
  • Phone: 352-502-3126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11030286
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: