Healthcare Provider Details

I. General information

NPI: 1538752449
Provider Name (Legal Business Name): MRS. AMY MARIE SPAHIC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2021
Last Update Date: 02/11/2021
Certification Date: 02/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3546 SAINT JOHNS BLUFF RD S UNIT 108
JACKSONVILLE FL
32224-2714
US

IV. Provider business mailing address

2435 MARBLE DR
JACKSONVILLE FL
32211-4982
US

V. Phone/Fax

Practice location:
  • Phone: 904-624-8142
  • Fax:
Mailing address:
  • Phone: 904-624-8142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225500000X
TaxonomyRespiratory/Developmental/Rehabilitative Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: