Healthcare Provider Details

I. General information

NPI: 1285010447
Provider Name (Legal Business Name): AMANDA L WOLF AA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2015
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 PINELLAS ST
CLEARWATER FL
33756-3804
US

IV. Provider business mailing address

4203 W KNIGHTS AVE
TAMPA FL
33611-1361
US

V. Phone/Fax

Practice location:
  • Phone: 727-573-7777
  • Fax: 727-573-7710
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License NumberAA301
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: