Provider Demographics
NPI:1427867043
Name:WARD, AMANDA LEE (FNP-C)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEE
Last Name:WARD
Suffix:
Gender:
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5617 SKYTOP DR
Mailing Address - Street 2:
Mailing Address - City:LITHIA
Mailing Address - State:FL
Mailing Address - Zip Code:33547-4165
Mailing Address - Country:US
Mailing Address - Phone:813-530-4585
Mailing Address - Fax:
Practice Address - Street 1:5617 SKYTOP DR
Practice Address - Street 2:
Practice Address - City:LITHIA
Practice Address - State:FL
Practice Address - Zip Code:33547-4165
Practice Address - Country:US
Practice Address - Phone:813-530-4585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-07
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9318501163W00000X
FLAPRN11037020363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse