Healthcare Provider Details

I. General information

NPI: 1083035802
Provider Name (Legal Business Name): AMANDA HIRSCH NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2013
Last Update Date: 01/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 CRANES ROOST BLVD SUITE 1220
ALTAMONTE SPRINGS FL
32701
US

IV. Provider business mailing address

1890 STATE ROAD 436 STE 215
WINTER PARK FL
32792-2285
US

V. Phone/Fax

Practice location:
  • Phone: 407-774-3325
  • Fax:
Mailing address:
  • Phone: 407-678-4040
  • Fax: 407-678-6935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9277110
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: