=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730575143
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMANDA BYRD MCCORMACK ARNP, PMHNP-BC, NP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/13/2015
-----------------------------------------------------
Last Update Date | 01/28/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8222 COUNTY ROAD 48
-----------------------------------------------------
City | YALAHA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34797-3168
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-217-4188
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8222 COUNTY ROAD 48
-----------------------------------------------------
City | YALAHA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34797-3168
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-217-4188
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 9164870
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | ARNP9164870
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------