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General NPI Number Information
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NPI Number | 1871415364
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Entity Type | Individual
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Provider Name | AMANDA IVANKOVIC TAGGART
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Gender | Female
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Dates
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Enumeration Date | 07/28/2026
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Last Update Date | 07/28/2026
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Provider Practice Location Address
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Address Line | 18057 REPUBLIC AVE
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City | PORT CHARLOTTE
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State | FL
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Zip | 33948-9370
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Country | US
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Telephone | 941-268-3593
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Fax |
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Provider Business Mailing Address
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Address Line | 18057 REPUBLIC AVE
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City | PORT CHARLOTTE
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State | FL
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Zip | 33948-9370
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Country | US
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Telephone |
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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 | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | LSP.0324
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 10282629
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License Number State | AR
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Taxonomy #3
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 1281097
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License Number State | FL
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