Healthcare Provider Details

I. General information

NPI: 1316469505
Provider Name (Legal Business Name): AMBER LYNN GIANNOTTA BA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMBER LYNN PIERCY

II. Dates (important events)

Enumeration Date: 07/10/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 DELTONA BLVD
SAINT AUGUSTINE FL
32086-4203
US

IV. Provider business mailing address

269 TIMBERWOOD DR
SAINT AUGUSTINE FL
32084-8391
US

V. Phone/Fax

Practice location:
  • Phone: 904-794-0268
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: