MEDICARE: AMANDA VALENTINE CPNP

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	163W00000X	Registered Nurse	199041	NC

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	:	1548516594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA VALENTINE CPNP

Provider Business Mailing Address
First Line	:	1721 SW GATLIN BLVD
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34953-2757
Country	:	US
Telephone Number	:	772-872-7114
Fax Number	:	728-737-1157

Provider Business Practice Location Address
First Line	:	1721 SW GATLIN BLVD
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34953-2757
Country	:	US
Telephone Number	:	772-873-7114
Fax Number	:	772-873-7115

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

Provider Enumeration Date	:	07/27/2012
Last Update Date	:	12/26/2023

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