Healthcare Provider Details

I. General information

NPI: 1649849431
Provider Name (Legal Business Name): AMANDA MARIE BURNS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA LEITHEAD

II. Dates (important events)

Enumeration Date: 06/24/2021
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10150 HIGHLAND MANOR DR STE 205
TAMPA FL
33610-9727
US

IV. Provider business mailing address

10150 HIGHLAND MANOR DR STE 205
TAMPA FL
33610-9727
US

V. Phone/Fax

Practice location:
  • Phone: 813-259-1013
  • Fax: 813-254-0396
Mailing address:
  • Phone: 813-259-1013
  • Fax: 813-254-0396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11014364
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: