Provider Demographics
NPI:1376037358
Name:WASHINGTON, AMANDA REBECCA
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:REBECCA
Last Name:WASHINGTON
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 1:4222 22ND AVE S
Mailing Address - Street 2:#531331
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33711-2952
Mailing Address - Country:US
Mailing Address - Phone:727-209-7915
Mailing Address - Fax:
Practice Address - Street 1:4222 22ND AVE S
Practice Address - Street 2:#531331
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33711-2952
Practice Address - Country:US
Practice Address - Phone:727-209-7915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-21
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty