Provider Demographics
NPI:1407682032
Name:PIASECKI, AMANDA LYNN (RN, LM)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:LYNN
Last Name:PIASECKI
Suffix:
Gender:F
Credentials:RN, LM
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:LYNN
Other - Last Name:KELLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:611 SW FEDERAL HWY STE M
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-2925
Mailing Address - Country:US
Mailing Address - Phone:772-200-4277
Mailing Address - Fax:772-919-4280
Practice Address - Street 1:611 SW FEDERAL HWY STE M
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2925
Practice Address - Country:US
Practice Address - Phone:772-200-4277
Practice Address - Fax:772-919-4280
Is Sole Proprietor?:No
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9381951163WH0200X
FLMW473176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No163WH0200XNursing Service ProvidersRegistered NurseHome Health