Healthcare Provider Details

I. General information

NPI: 1861337289
Provider Name (Legal Business Name): WHITNEY AMANDA MCFATTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 NW OUTLAW COUNTRY GLN
LAKE CITY FL
32055-9212
US

IV. Provider business mailing address

285 NW OUTLAW COUNTRY GLN
LAKE CITY FL
32055-9212
US

V. Phone/Fax

Practice location:
  • Phone: 386-515-5539
  • Fax:
Mailing address:
  • Phone: 386-515-5539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN11046577
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: