Healthcare Provider Details

I. General information

NPI: 1972098317
Provider Name (Legal Business Name): AMANDA JUSTINE FIJI AGNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2018
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8060 SPYGLASS HILL RD
VIERA FL
32940-7983
US

IV. Provider business mailing address

8060 SPYGLASS HILL RD
VIERA FL
32940-7983
US

V. Phone/Fax

Practice location:
  • Phone: 321-806-1874
  • Fax: 321-806-1875
Mailing address:
  • Phone: 321-806-1874
  • Fax: 321-806-1875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number9273003
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number9273003
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: