Healthcare Provider Details

I. General information

NPI: 1558099150
Provider Name (Legal Business Name): AMORIE BROOKE WRIGHT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2022
Last Update Date: 08/11/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 EAGLE COVE DR
FLEMING ISLAND FL
32003-3239
US

IV. Provider business mailing address

745 EAGLE COVE DR
FLEMING ISLAND FL
32003-3239
US

V. Phone/Fax

Practice location:
  • Phone: 757-679-2252
  • Fax:
Mailing address:
  • Phone: 757-679-2252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11020761
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: