Healthcare Provider Details

I. General information

NPI: 1114593266
Provider Name (Legal Business Name): AMANDA LEE TORTORICE C-PNP, APRN, MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2021
Last Update Date: 05/31/2021
Certification Date: 05/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2195 CABOOSE LN APT 200
ODESSA FL
33556-3598
US

IV. Provider business mailing address

2195 CABOOSE LN APT 200
ODESSA FL
33556-3598
US

V. Phone/Fax

Practice location:
  • Phone: 727-503-8592
  • Fax:
Mailing address:
  • Phone: 727-503-8592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number11012736
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: