Healthcare Provider Details

I. General information

NPI: 1427978923
Provider Name (Legal Business Name): AMANDA ILARIA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 BELMONT ST
BROCKTON MA
02301-5596
US

IV. Provider business mailing address

21 CENTURY ST # 2
SOMERVILLE MA
02145-1403
US

V. Phone/Fax

Practice location:
  • Phone: 508-583-4500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN2345127
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: