Healthcare Provider Details

I. General information

NPI: 1700437894
Provider Name (Legal Business Name): AMANDA D'ERCOLE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2019
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1524 ATWOOD AVE
JOHNSTON RI
02919-3228
US

IV. Provider business mailing address

673 NE 3RD AVE APT 224
FORT LAUDERDALE FL
33304-2723
US

V. Phone/Fax

Practice location:
  • Phone: 401-273-9400
  • Fax:
Mailing address:
  • Phone: 401-230-4798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11004327
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9290794
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: