Healthcare Provider Details

I. General information

NPI: 1366761546
Provider Name (Legal Business Name): AMANDA CAMP ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2010
Last Update Date: 08/07/2023
Certification Date: 08/07/2023
Deactivation Date: 04/24/2023
Reactivation Date: 06/05/2023

III. Provider practice location address

2835 W DE LEON ST STE 201
TAMPA FL
33609-4130
US

IV. Provider business mailing address

2835 W DE LEON ST STE 201
TAMPA FL
33609-4130
US

V. Phone/Fax

Practice location:
  • Phone: 727-428-6344
  • Fax: 813-350-0703
Mailing address:
  • Phone: 727-428-6344
  • Fax: 813-350-0703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number9166980
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberARNP9166980
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: