1639540438 NPI number — MRS. AMANDA MCGUIRE HENDRICK M.S.

Table of content: MRS. AMANDA MCGUIRE HENDRICK M.S. (NPI 1639540438)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639540438 NPI number — MRS. AMANDA MCGUIRE HENDRICK M.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HENDRICK
Provider First Name:
AMANDA
Provider Middle Name:
MCGUIRE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HENDRICK
Provider Other First Name:
MIA
Provider Other Middle Name:
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.S.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1639540438
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/19/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
712 S HOWARD AVE
Provider Second Line Business Mailing Address:
APARTMENT 340
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33606-2430
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-223-2467
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6152 DELANCEY STATION ST
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
RIVERVIEW
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33578-4206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-767-0763
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/19/2015

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: 235Z00000X , with the licence number:  SZ7311 , 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)





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