Healthcare Provider Details

I. General information

NPI: 1023817004
Provider Name (Legal Business Name): AMANDA R. URIARTE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2025
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 VETERANS PARK DR STE 201
NAPLES FL
34109-0446
US

IV. Provider business mailing address

21190 WHITE OAK AVE
BOCA RATON FL
33428-1715
US

V. Phone/Fax

Practice location:
  • Phone: 239-260-1033
  • Fax: 239-260-1491
Mailing address:
  • Phone: 561-405-8325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9120252
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: