Provider Demographics
NPI:1114899960
Name:WEAVER, AMANDA D (CPHT, RPT, PMP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:D
Last Name:WEAVER
Suffix:
Gender:F
Credentials:CPHT, RPT, PMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 SILVER MYRTLE CT
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-0140
Mailing Address - Country:US
Mailing Address - Phone:954-701-4242
Mailing Address - Fax:
Practice Address - Street 1:249 SILVER MYRTLE CT
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092-0140
Practice Address - Country:US
Practice Address - Phone:954-701-4242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-22
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRPT2657156F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist