Healthcare Provider Details

I. General information

NPI: 1518689876
Provider Name (Legal Business Name): AMANDA BARNES MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2022
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 SOUTHPARK BLVD STE 208
ST AUGUSTINE FL
32086-5179
US

IV. Provider business mailing address

15 FRANCISCAN WAY
ST AUGUSTINE FL
32080-5307
US

V. Phone/Fax

Practice location:
  • Phone: 904-675-0739
  • Fax:
Mailing address:
  • Phone: 623-760-6879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH22525
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH26825
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: