Healthcare Provider Details

I. General information

NPI: 1902243504
Provider Name (Legal Business Name): AMANDA NICOLE HUGHES CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2013
Last Update Date: 05/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1304 OAK ST
MELBOURNE FL
32901-3111
US

IV. Provider business mailing address

1285 HOLLOW BROOK LN
MALABAR FL
32950-6817
US

V. Phone/Fax

Practice location:
  • Phone: 321-723-4723
  • Fax: 321-727-1448
Mailing address:
  • Phone: 321-794-8453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9282571
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: