1326570524 NPI number — MISS AMANDA JANE WARNER D.P.M.

Table of content: MISS AMANDA JANE WARNER D.P.M. (NPI 1326570524)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326570524 NPI number — MISS AMANDA JANE WARNER D.P.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WARNER
Provider First Name:
AMANDA
Provider Middle Name:
JANE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
D.P.M.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326570524
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/03/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5301 S CONGRESS AVE
Provider Second Line Business Mailing Address:
3 SOUTH
Provider Business Mailing Address City Name:
ATLANTIS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33462-1149
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-548-1711
Provider Business Mailing Address Fax Number:
561-548-1743

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5301 S CONGRESS AVE
Provider Second Line Business Practice Location Address:
3 SOUTH
Provider Business Practice Location Address City Name:
ATLANTIS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33462-1149
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-548-1711
Provider Business Practice Location Address Fax Number:
561-548-1743
Provider Enumeration Date:
03/28/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  683 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 390200000X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)