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General NPI Number Information
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NPI Number | 1467267443
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Entity Type | Individual
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Provider Name | AMANDA ELY RRA/RPA, RT(R)(CT)
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Gender | Female
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Dates
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Enumeration Date | 02/08/2025
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Last Update Date | 02/08/2025
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Provider Practice Location Address
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Address Line | 1250 S 18TH ST
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034-1902
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Country | US
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Telephone | 904-321-3500
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Fax |
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Provider Business Mailing Address
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Address Line | 75297 SEMPER FI DR
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City | YULEE
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State | FL
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Zip | 32097-1704
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Country | US
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Telephone | 904-657-7799
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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 | 2471C3401X
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Taxonomy Name | Computed Tomography Radiologic Technologist
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License Number | CRT85880
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License Number State | FL
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