Healthcare Provider Details

I. General information

NPI: 1881863652
Provider Name (Legal Business Name): AMANDA KRISTEN GRAHAM ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA KRISTEN KLIPA ARNP

II. Dates (important events)

Enumeration Date: 02/26/2008
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 N LEE ST STE 203
JACKSONVILLE FL
32204-1128
US

IV. Provider business mailing address

27 MARCO ISLAND WAY
PONTE VEDRA FL
32081-0532
US

V. Phone/Fax

Practice location:
  • Phone: 904-354-8200
  • Fax: 904-354-1340
Mailing address:
  • Phone: 904-616-0322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberARNP9201902
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9201902
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: