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General NPI Number Information
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NPI Number | 1467228916
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Entity Type | Individual
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Provider Name | MISS AMANDA DOLL
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Gender | Female
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Dates
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Enumeration Date | 11/27/2023
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 1355 PROVIDENCE RD
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City | BRANDON
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State | FL
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Zip | 33511-4885
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Country | US
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Telephone | 813-651-4441
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Fax |
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Provider Business Mailing Address
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Address Line | 1355 PROVIDENCE RD
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City | BRANDON
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State | FL
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Zip | 33511-4885
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Country | US
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Telephone | 813-651-4441
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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 | 9119905
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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 | 5601012455
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 11165
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License Number State | AZ
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