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General NPI Number Information
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NPI Number | 1881863652
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Entity Type | Individual
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Provider Name | AMANDA KRISTEN GRAHAM ARNP
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Gender | Female
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Dates
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Enumeration Date | 02/26/2008
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Last Update Date | 09/12/2024
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Provider Practice Location Address
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Address Line | 425 N LEE ST STE 203
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City | JACKSONVILLE
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State | FL
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Zip | 32204-1128
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Country | US
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Telephone | 904-354-8200
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Fax | 904-354-1340
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Provider Business Mailing Address
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Address Line | 27 MARCO ISLAND WAY
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City | PONTE VEDRA
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State | FL
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Zip | 32081-0532
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Country | US
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Telephone | 904-616-0322
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | ARNP9201902
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | ARNP9201902
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License Number State | FL
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