Healthcare Provider Details

I. General information

NPI: 1326960063
Provider Name (Legal Business Name): AMANDA DEE ROTROFF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1517 23RD ST
NICEVILLE FL
32578-3326
US

IV. Provider business mailing address

1517 23RD ST
NICEVILLE FL
32578-3326
US

V. Phone/Fax

Practice location:
  • Phone: 770-846-2235
  • Fax:
Mailing address:
  • Phone: 770-846-2235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9584663
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: