Provider Demographics
NPI:1699073551
Name:FLORENTINO, AMANDA A (RN)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:A
Last Name:FLORENTINO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 E TIPTON ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:46750-2254
Mailing Address - Country:US
Mailing Address - Phone:260-519-1818
Mailing Address - Fax:
Practice Address - Street 1:4665 E SUNSET DR
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:IN
Practice Address - Zip Code:46567-9168
Practice Address - Country:US
Practice Address - Phone:866-627-8233
Practice Address - Fax:877-710-7891
Is Sole Proprietor?:No
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28187454A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse