Healthcare Provider Details

I. General information

NPI: 1881935559
Provider Name (Legal Business Name): AMANDA CORRINE MAUCERE MS RD LD/N
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2013
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13715 RANGELAND BLVD
ODESSA FL
33556-4648
US

IV. Provider business mailing address

13715 RANGELAND BLVD
ODESSA FL
33556-4648
US

V. Phone/Fax

Practice location:
  • Phone: 727-534-9742
  • Fax:
Mailing address:
  • Phone: 727-534-9742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND 5431
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: