Healthcare Provider Details

I. General information

NPI: 1841565793
Provider Name (Legal Business Name): AMANDA LOUISE GIRARD RN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2012
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5905 US HIGHWAY 301 S
RIVERVIEW FL
33578-3800
US

IV. Provider business mailing address

5905 US HIGHWAY 301 S
RIVERVIEW FL
33578-3800
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2011039059
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11026939
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: