Provider Demographics
NPI:1245616283
Name:TAYLOR, AMANDA HIRSCH
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:HIRSCH
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7310 STEVENTON WAY
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-8166
Mailing Address - Country:US
Mailing Address - Phone:904-537-7040
Mailing Address - Fax:
Practice Address - Street 1:4320 DEERWOOD LAKE PKWY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-1177
Practice Address - Country:US
Practice Address - Phone:904-620-8344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-31
Last Update Date:2023-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS53708183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist