1467261875 NPI number — SPINE AND NERVE CENTER RIVERVIEW, LLC

Table of content: AMANDA LEIGH HARRELL PSY.D. (NPI 1659603967)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467261875 NPI number — SPINE AND NERVE CENTER RIVERVIEW, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPINE AND NERVE CENTER RIVERVIEW, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1467261875
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/11/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13023 SUMMERFIELD SQUARE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIVERVIEW
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33578-7402
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-741-1071
Provider Business Mailing Address Fax Number:
833-664-4104

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13023 SUMMERFIELD SQUARE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIVERVIEW
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33578-7402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-741-1071
Provider Business Practice Location Address Fax Number:
866-709-3257
Provider Enumeration Date:
01/01/2025

Additional Information

Authorized Official

Authorized Official Last Name:
FURA
Authorized Official First Name:
ABRAHAM
Authorized Official Middle Name:
JOSIAH
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
831-741-1071

Provider Taxonomy Codes

  • Taxonomy code: 208VP0014X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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