Healthcare Provider Details

I. General information

NPI: 1821964438
Provider Name (Legal Business Name): AMELIA JAYNE TRIPP MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2025
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 EMBASSY DR STE 13
HOLLYWOOD FL
33026-4573
US

IV. Provider business mailing address

11433 BOCA WOODS LN
BOCA RATON FL
33428-1823
US

V. Phone/Fax

Practice location:
  • Phone: 754-888-9616
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number19350
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: