Healthcare Provider Details

I. General information

NPI: 1801713748
Provider Name (Legal Business Name): AMANDA SOARES RODRIGUES KOPPE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 3RD ST STE D
NEPTUNE BEACH FL
32266-5062
US

IV. Provider business mailing address

804 3RD ST STE D
NEPTUNE BEACH FL
32266-5062
US

V. Phone/Fax

Practice location:
  • Phone: 904-746-7258
  • Fax: 904-746-3321
Mailing address:
  • Phone: 904-746-7258
  • Fax: 904-746-3321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: