Healthcare Provider Details

I. General information

NPI: 1730737511
Provider Name (Legal Business Name): AMY G MORGAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2019
Last Update Date: 06/08/2022
Certification Date: 06/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15211 CORTEZ BLVD
BROOKSVILLE FL
34613-6072
US

IV. Provider business mailing address

14690 SPRING HILL DR STE 305
SPRING HILL FL
34609-8102
US

V. Phone/Fax

Practice location:
  • Phone: 352-345-4565
  • Fax: 352-596-6051
Mailing address:
  • Phone: 352-277-5348
  • Fax: 352-606-2857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN9434871
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11004929
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: