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NPI Code Detail

MEDICARE: DR. AMANDA BARTELL D.P.M.

MEDICARE:  DR. AMANDA  BARTELL  D.P.M.
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
1213E00000XPodiatristP03128FL

General Provider Information

NPI Number : 1366429862
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. AMANDA BARTELL D.P.M.
Provider Business Mailing Address
First Line : 465 TOWN PLAZA AVE STE A
Second Line :
City : PONTE VEDRA
State : FL
Zip : 32081-5164
Country : US
Telephone Number : 904-236-5023
Fax Number : 904-236-5073
Provider Business Practice Location Address
First Line : 465 TOWN PLAZA AVE STE A
Second Line :
City : PONTE VEDRA
State : FL
Zip : 32081-5164
Country : US
Telephone Number : 904-236-5023
Fax Number : 904-236-5073
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/27/2005
Last Update Date : 01/28/2022

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Directions to “ DR. AMANDA BARTELL D.P.M.” Practice Location

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