Healthcare Provider Details

I. General information

NPI: 1962700575
Provider Name (Legal Business Name): AMY MARIE HARVICK ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2011
Last Update Date: 12/26/2019
Certification Date: 12/26/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 DON WICKHAM DR
CLERMONT FL
34711
US

IV. Provider business mailing address

1900 DON WICKHAM DR
CLERMONT FL
34711
US

V. Phone/Fax

Practice location:
  • Phone: 321-843-3220
  • Fax: 321-843-3210
Mailing address:
  • Phone: 321-843-3220
  • Fax: 321-843-3210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1039112
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN1039112
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: