Healthcare Provider Details

I. General information

NPI: 1619326949
Provider Name (Legal Business Name): AMANDA KAY PAGELS DAMKJER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2016
Last Update Date: 03/10/2022
Certification Date: 01/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10701 INTERNATIONAL DR
ORLANDO FL
32821-7392
US

IV. Provider business mailing address

10701 INTERNATIONAL DR
ORLANDO FL
32821-7392
US

V. Phone/Fax

Practice location:
  • Phone: 407-355-0929
  • Fax:
Mailing address:
  • Phone: 866-389-2727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9316502
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: