Healthcare Provider Details

I. General information

NPI: 1760791107
Provider Name (Legal Business Name): AMIE NICHOLE PETERSON ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2010
Last Update Date: 08/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

YOUR HEALTH ORG. OF FLORIDA 1301 PLANTATION ISLAND DR. UNIT 303B
ST. AUGUSTINE FL
32080
US

IV. Provider business mailing address

SC HOUSE CALLS INC. 111 DOCTORS CIR.
COLUMBIA SC
29203
US

V. Phone/Fax

Practice location:
  • Phone: 800-491-0909
  • Fax: 239-343-9218
Mailing address:
  • Phone: 800-491-0909
  • Fax: 239-424-1421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number2629902
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN2629902
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: