Healthcare Provider Details

I. General information

NPI: 1588026728
Provider Name (Legal Business Name): DR. AMANDA RATLIFF DAILEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA ANN RATLIFF

II. Dates (important events)

Enumeration Date: 03/27/2016
Last Update Date: 12/07/2025
Certification Date: 12/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 APOLLO BEACH BLVD
APOLLO BEACH FL
33572-2281
US

IV. Provider business mailing address

PO BOX 917770
ORLANDO FL
32891-0001
US

V. Phone/Fax

Practice location:
  • Phone: 813-645-8494
  • Fax: 813-645-0912
Mailing address:
  • Phone: 813-821-8038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberME133617
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME133617
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: