Healthcare Provider Details

I. General information

NPI: 1013571157
Provider Name (Legal Business Name): ANDREW AMICARELLI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2019
Last Update Date: 05/06/2024
Certification Date: 05/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 NEWELL DR
GAINESVILLE FL
32611-1912
US

IV. Provider business mailing address

PO BOX 100256 1149 NEWELL DR L4-100
GAINESVILLE FL
32611-0001
US

V. Phone/Fax

Practice location:
  • Phone: 352-294-4900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberOS19963
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: