Healthcare Provider Details

I. General information

NPI: 1972150050
Provider Name (Legal Business Name): REBECCA ROSE AMOS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2019
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5721 RICHEY DR
PORT RICHEY FL
34668-6057
US

IV. Provider business mailing address

3251 N MCMULLEN BOOTH RD STE 303
CLEARWATER FL
33761-2022
US

V. Phone/Fax

Practice location:
  • Phone: 727-807-9754
  • Fax: 727-669-9742
Mailing address:
  • Phone: 727-725-6110
  • Fax: 727-669-9742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberARNP11002781
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: