Healthcare Provider Details

I. General information

NPI: 1689626962
Provider Name (Legal Business Name): AMANDA ADAMS RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1126 LEE AVE
TALLAHASSEE FL
32303-6508
US

IV. Provider business mailing address

1126 LEE AVE
TALLAHASSEE FL
32303-6508
US

V. Phone/Fax

Practice location:
  • Phone: 850-488-7935
  • Fax: 850-488-0918
Mailing address:
  • Phone: 850-488-7935
  • Fax: 850-488-0918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN9214352
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: