Healthcare Provider Details

I. General information

NPI: 1083394977
Provider Name (Legal Business Name): AMANDA DEE FLORES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2023
Last Update Date: 08/21/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 BRIARWOOD AVE
MIDLAND TX
79707-2753
US

IV. Provider business mailing address

4317 FERNCLIFF AVE
MIDLAND TX
79707-5421
US

V. Phone/Fax

Practice location:
  • Phone: 432-682-5385
  • Fax:
Mailing address:
  • Phone: 432-788-0977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1129646
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: