MEDICARE: MS. AMY LEE VLACICH AP

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	171100000X	Acupuncturist	264	NH
2	171100000X	Acupuncturist	4087	FL

General Provider Information

NPI Number	:	1215441076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMY LEE VLACICH AP

Provider Business Mailing Address
First Line	:	2919 DARTMOUTH AVE N
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33713-7725
Country	:	US
Telephone Number	:	727-371-6565
Fax Number	:

Provider Business Practice Location Address
First Line	:	1511 4TH ST N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33704-4411
Country	:	US
Telephone Number	:	727-289-7250
Fax Number	:

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

Provider Enumeration Date	:	11/30/2017
Last Update Date	:	07/10/2021

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