Healthcare Provider Details

I. General information

NPI: 1659204030
Provider Name (Legal Business Name): AMANDA GREEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3231 MCMULLEN BOOTH RD
SAFETY HARBOR FL
34695-6607
US

IV. Provider business mailing address

1930 BARRINGTON DR W
CLEARWATER FL
33763-4404
US

V. Phone/Fax

Practice location:
  • Phone: 727-725-6111
  • Fax:
Mailing address:
  • Phone: 737-703-9589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberRN9676695
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: