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General NPI Number Information
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NPI Number | 1982015574
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Entity Type | Individual
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Provider Name | AMANDA HAFER D.O.
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Gender | Female
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Dates
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Enumeration Date | 05/16/2014
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Last Update Date | 08/09/2019
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Provider Practice Location Address
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Address Line | 1040 RIVER HERITAGE BLVD
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City | BRADENTON
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State | FL
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Zip | 34212-6348
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Country | US
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Telephone | 941-917-6443
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Fax |
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Provider Business Mailing Address
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Address Line | 12216 LONGVIEW LAKE CIR
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City | BRADENTON
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State | FL
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Zip | 34211-4965
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Country | US
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Telephone | 717-372-5920
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS14465
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License Number State | FL
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