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NPI Code Detail

MEDICARE: AMANDA SURUJBALI APRN

MEDICARE: AMANDA SURUJBALI APRN
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
1363LA2100XAcute Care Nurse Practitioner11034927FL
2363LG0600XGerontology Nurse PractitionerAPRN11034927FL

General Provider Information

NPI Number : 1407689664
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA SURUJBALI APRN
Provider Business Mailing Address
First Line : 2995 DREW ST
Second Line :
City : CLEARWATER
State : FL
Zip : 33759-3012
Country : US
Telephone Number : 727-315-7496
Fax Number :
Provider Business Practice Location Address
First Line : 2727 W DR MARTIN LUTHER KING JR BLVD STE 460
Second Line :
City : TAMPA
State : FL
Zip : 33607-6001
Country : US
Telephone Number : 813-879-4328
Fax Number : 813-443-8152
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/22/2024
Last Update Date : 11/21/2024

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Directions to “ AMANDA SURUJBALI APRN” Practice Location

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