Provider Demographics
NPI:1972810976
Name:DIBENEDETTO, AMANDA LYNN (FNP - C)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:LYNN
Last Name:DIBENEDETTO
Suffix:
Gender:F
Credentials:FNP - C
Other - Prefix:
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Mailing Address - Street 1:4513 WILLIAMS DR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78633-1302
Mailing Address - Country:US
Mailing Address - Phone:512-930-3909
Mailing Address - Fax:512-869-5868
Practice Address - Street 1:4513 WILLIAMS DR
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78633-1302
Practice Address - Country:US
Practice Address - Phone:512-930-3909
Practice Address - Fax:512-869-5868
Is Sole Proprietor?:No
Enumeration Date:2010-09-12
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXAP119335363LF0000X
TX697750363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily