Healthcare Provider Details

I. General information

NPI: 1902572910
Provider Name (Legal Business Name): AMANDA CIOFFI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2021
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7524 SOUTHSIDE BLVD APT 906
JACKSONVILLE FL
32256-0401
US

IV. Provider business mailing address

7524 SOUTHSIDE BLVD APT 906
JACKSONVILLE FL
32256-0401
US

V. Phone/Fax

Practice location:
  • Phone: 904-235-9826
  • Fax:
Mailing address:
  • Phone: 904-631-7297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: