Provider Demographics
NPI:1881561264
Name:QUEEN, AMBER DAWN
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:DAWN
Last Name:QUEEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3214 US HIGHWAY 19 # 208
Mailing Address - Street 2:
Mailing Address - City:HOLIDAY
Mailing Address - State:FL
Mailing Address - Zip Code:34691-1844
Mailing Address - Country:US
Mailing Address - Phone:727-337-8960
Mailing Address - Fax:
Practice Address - Street 1:3214 US HIGHWAY 19 # 208
Practice Address - Street 2:
Practice Address - City:HOLIDAY
Practice Address - State:FL
Practice Address - Zip Code:34691-1844
Practice Address - Country:US
Practice Address - Phone:727-337-8960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-21
Last Update Date:2025-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician