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General NPI Number Information
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NPI Number | 1346620069
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Entity Type | Individual
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Provider Name | AMANDA J LIECHTY PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/08/2015
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Last Update Date | 04/16/2025
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Provider Practice Location Address
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Address Line | 5857 ARGERIAN DR STE 102
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City | WESLEY CHAPEL
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State | FL
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Zip | 33545-4507
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Country | US
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Telephone | 813-876-7073
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Fax | 813-877-1277
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Provider Business Mailing Address
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Address Line | 4927 VAN DYKE RD
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City | LUTZ
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State | FL
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Zip | 33558-4813
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Country | US
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Telephone | 813-480-2892
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | MA058558
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License Number State | PA
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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 |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9116134
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License Number State | FL
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