Healthcare Provider Details

I. General information

NPI: 1811221484
Provider Name (Legal Business Name): AMANDA K HUFFMAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2009
Last Update Date: 01/31/2022
Certification Date: 01/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22655 BAYSHORE RD STE 130
PORT CHARLOTTE FL
33980
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 941-255-3722
  • Fax: 941-255-3723
Mailing address:
  • Phone: 941-255-3722
  • Fax: 941-255-3723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberAPRN9272299
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9272299
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: