Healthcare Provider Details

I. General information

NPI: 1336526532
Provider Name (Legal Business Name): AMANDA KOVACICH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2015
Last Update Date: 02/05/2026
Certification Date: 02/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1222 S ORANGE AVE FL 2
ORLANDO FL
32806-1215
US

IV. Provider business mailing address

1414 KUHL AVE # MP38
ORLANDO FL
32806-2008
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-7856
  • Fax: 321-843-6432
Mailing address:
  • Phone: 321-842-4713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2018-01726
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberME156351
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME156351
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number2018-01726
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: