MEDICARE: AMY LYNN WILLITZER A.R.N.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	ARNP3173442	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043337785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY LYNN WILLITZER A.R.N.P.

Provider Business Mailing Address
First Line	:	3838 W NEPTUNE ST
Second Line	:	SUITE D5, SOUTH TOWN CENTER
City	:	TAMPA
State	:	FL
Zip	:	33629-5841
Country	:	US
Telephone Number	:	813-837-0221
Fax Number	:	813-832-2973

Provider Business Practice Location Address
First Line	:	3838 W NEPTUNE ST
Second Line	:	SUITE D5, SOUTH TOWN CENTER
City	:	TAMPA
State	:	FL
Zip	:	33629-5841
Country	:	US
Telephone Number	:	813-837-0221
Fax Number	:	813-832-2973

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	09/23/2008

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