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General NPI Number Information
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NPI Number | 1326198862
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Entity Type | Individual
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Provider Name | AMANDA WEAVER MMS, PA-C, MS, ATC
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Gender | Female
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 07/04/2018
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Provider Practice Location Address
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Address Line | 1220 RESERVE WAY #306
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City | NAPLES
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State | FL
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Zip | 34105
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Country | US
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Telephone | 239-682-2332
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Fax |
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Provider Business Mailing Address
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Address Line | 1220 RESERVE WAY #306
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City | NAPLES
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State | FL
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Zip | 34105-3815
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Country | US
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Telephone | 239-682-2332
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AL 1743
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9111111
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License Number State | FL
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