Healthcare Provider Details

I. General information

NPI: 1760907562
Provider Name (Legal Business Name): AMANDA SWINT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

853 JEFFERSON AVE # E206
MEMPHIS TN
38103-2807
US

IV. Provider business mailing address

853 JEFFERSON AVE # E206
MEMPHIS TN
38103-2807
US

V. Phone/Fax

Practice location:
  • Phone: 901-448-6728
  • Fax:
Mailing address:
  • Phone: 901-448-6728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number22149
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: