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General NPI Number Information
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NPI Number | 1689813305
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Entity Type | Individual
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Provider Name | AMANDA PHILLIPS FNP-BC, PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 02/19/2009
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Last Update Date | 08/15/2024
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Provider Practice Location Address
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Address Line | 420 STADIUM RD
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-2400
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Country | US
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Telephone | 386-236-1780
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Fax |
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Provider Business Mailing Address
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Address Line | 420 STADIUM RD
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-2400
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Country | US
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Telephone | 386-254-1149
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Fax | 386-236-3300
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APN0000013916
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN9329067
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN9329067
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License Number State | FL
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