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General NPI Number Information
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NPI Number | 1952093981
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Entity Type | Individual
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Provider Name | AMY HUMPHREYS REVELS APRN
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Gender | Female
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Dates
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Enumeration Date | 05/26/2023
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Last Update Date | 07/24/2025
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Provider Practice Location Address
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Address Line | 2000 NEBRAKSA AVE
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City | FORT PIERCE
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State | FL
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Zip | 34950-4832
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Country | US
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Telephone | 772-465-4444
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Fax | 772-466-4499
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Provider Business Mailing Address
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Address Line | 2000 NEBRAKSA AVE
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City | FORT PIERCE
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State | FL
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Zip | 34950
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Country | US
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Telephone | 772-465-4444
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Fax | 772-466-4499
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 11026609
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 11026609
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN9499830
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License Number State | FL
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