Healthcare Provider Details

I. General information

NPI: 1275048290
Provider Name (Legal Business Name): AMANDA MARIE TEZYK ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2017
Last Update Date: 07/31/2020
Certification Date: 07/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8260 GLADIOLUS DR
FORT MYERS FL
33908-4156
US

IV. Provider business mailing address

4371 VERONICA S SHOEMAKER BLVD
FORT MYERS FL
33916-2216
US

V. Phone/Fax

Practice location:
  • Phone: 239-437-5755
  • Fax: 239-437-5776
Mailing address:
  • Phone: 239-274-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9355879
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: