Healthcare Provider Details

I. General information

NPI: 1871423491
Provider Name (Legal Business Name): AMANDA SERRETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2026
Last Update Date: 05/23/2026
Certification Date: 05/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 TAGGART ST
COLONIAL BEACH VA
22443-2234
US

IV. Provider business mailing address

508 TAGGART ST
COLONIAL BEACH VA
22443-2234
US

V. Phone/Fax

Practice location:
  • Phone: 804-223-4856
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License NumberE081609901
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: