=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134855257
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMBERLYN DAGLIAN MCNAMARA APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/29/2022
-----------------------------------------------------
Last Update Date | 04/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 350G RACETRACK RD NW
-----------------------------------------------------
City | FORT WALTON BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32547-1699
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-374-3125
-----------------------------------------------------
Fax | 850-226-5544
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 350G RACETRACK RD NW
-----------------------------------------------------
City | FORT WALTON BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32547-1699
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-374-3125
-----------------------------------------------------
Fax | 850-226-5544
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | APRN-3723
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | APRN11034616
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------