Healthcare Provider Details

I. General information

NPI: 1992667497
Provider Name (Legal Business Name): AMENITY HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7901 4TH ST N # 18547
ST PETERSBURG FL
33702-4305
US

IV. Provider business mailing address

7901 4TH ST N # 18547
ST PETERSBURG FL
33702-4305
US

V. Phone/Fax

Practice location:
  • Phone: 813-708-6561
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. CHRISTINA BRADDY
Title or Position: FAMILY NURSE PRACTITIONER
Credential: NP
Phone: 813-629-0442