Healthcare Provider Details

I. General information

NPI: 1821849233
Provider Name (Legal Business Name): AMANDA BARBER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2024
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1131 W NEW HAVEN AVE
MELBOURNE FL
32904-4110
US

IV. Provider business mailing address

3300 S FISKE BLVD
ROCKLEDGE FL
32955-4306
US

V. Phone/Fax

Practice location:
  • Phone: 321-434-1744
  • Fax:
Mailing address:
  • Phone: 321-434-1744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11030224
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: