Provider Demographics
NPI:1104622125
Name:ROBERTS-GARCIA, AMANDA ARIEUX (PMHNP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:ARIEUX
Last Name:ROBERTS-GARCIA
Suffix:
Gender:
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1453 WAKEFIELD TER
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-1652
Mailing Address - Country:US
Mailing Address - Phone:321-626-2241
Mailing Address - Fax:
Practice Address - Street 1:1453 WAKEFIELD TER
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-1652
Practice Address - Country:US
Practice Address - Phone:321-626-2241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11037855363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty