Healthcare Provider Details

I. General information

NPI: 1548475593
Provider Name (Legal Business Name): AMY LYNAE VARNER LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 STATE ROAD 26 SUITE 200-3
MELROSE FL
32666-3902
US

IV. Provider business mailing address

PO BOX 357
MELROSE FL
32666-0357
US

V. Phone/Fax

Practice location:
  • Phone: 352-359-2412
  • Fax:
Mailing address:
  • Phone: 352-359-2412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA 42188
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: