Healthcare Provider Details

I. General information

NPI: 1255297495
Provider Name (Legal Business Name): AMANDA BURKETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2025
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 HIGHWAY 98 STE B
MEXICO BEACH FL
32456-9583
US

IV. Provider business mailing address

4020 WOODRIDGE RD
PANAMA CITY FL
32405-4817
US

V. Phone/Fax

Practice location:
  • Phone: 850-233-3376
  • Fax: 850-522-8354
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11044577
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: