Healthcare Provider Details

I. General information

NPI: 1538613245
Provider Name (Legal Business Name): AMANDA ZAPATA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2016
Last Update Date: 07/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE
MIAMI FL
33136-1005
US

IV. Provider business mailing address

15923 SW 139TH ST
MIAMI FL
33196-6462
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-1535
  • Fax:
Mailing address:
  • Phone: 786-395-4695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9349885
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: