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General NPI Number Information
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NPI Number | 1114203254
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Entity Type | Individual
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Provider Name | AMANDA JO TATE FNP, BC
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Gender | Female
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Dates
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Enumeration Date | 11/02/2011
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Last Update Date | 09/06/2016
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Provider Practice Location Address
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Address Line | 1098 MONTGOMERY RD
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32714-7420
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Country | US
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Telephone | 407-869-6463
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Fax |
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Provider Business Mailing Address
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Address Line | 2155 JUDGE FRAN JAMIESON WAY APT 210
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City | VIERA
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State | FL
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Zip | 32940
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Country | US
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Telephone | 304-641-0180
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 70863
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 9423463
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License Number State | FL
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