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General NPI Number Information
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NPI Number | 1013382365
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Entity Type | Individual
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Provider Name | MS. AMANDA K VAN VLIET
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Gender | Female
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Dates
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Enumeration Date | 12/10/2015
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Last Update Date | 03/17/2025
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Provider Practice Location Address
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Address Line | 7406 FULLERTON ST
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City | JACKSONVILLE
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State | FL
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Zip | 32256-3552
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Country | US
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Telephone | 904-802-6800
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Fax | 904-249-9764
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Provider Business Mailing Address
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Address Line | 7406 FULLERTON ST STE 105
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City | JACKSONVILLE
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State | FL
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Zip | 32256-3588
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Country | US
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Telephone | 904-802-6800
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Fax | 904-824-2353
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APRN9343112
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License Number State | FL
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