Provider Demographics
NPI:1366761546
Name:CAMP, AMANDA (ARNP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:CAMP
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2835 W DE LEON ST STE 201
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-4130
Mailing Address - Country:US
Mailing Address - Phone:727-428-6344
Mailing Address - Fax:813-350-0703
Practice Address - Street 1:2835 W DE LEON ST STE 201
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4130
Practice Address - Country:US
Practice Address - Phone:727-428-6344
Practice Address - Fax:813-350-0703
Is Sole Proprietor?:No
Enumeration Date:2010-05-27
Last Update Date:2023-08-07
Deactivation Date:2023-04-24
Deactivation Code:
Reactivation Date:2023-06-05
Provider Licenses
StateLicense IDTaxonomies
FL9166980363L00000X
FLARNP9166980363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner