Healthcare Provider Details

I. General information

NPI: 1891457180
Provider Name (Legal Business Name): AMBER LEE HAYMORE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMBER LEE PROFFITT APRN

II. Dates (important events)

Enumeration Date: 10/13/2021
Last Update Date: 04/12/2023
Certification Date: 04/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4216 CORTEZ RD W
BRADENTON FL
34210-3121
US

IV. Provider business mailing address

415 141ST CT NE
BRADENTON FL
34212-1679
US

V. Phone/Fax

Practice location:
  • Phone: 941-500-3100
  • Fax:
Mailing address:
  • Phone: 941-962-6088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number9477928
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11016239
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: