Provider Demographics
NPI:1477145050
Name:PAVLICH, AMANDA L (DOULA)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:L
Last Name:PAVLICH
Suffix:
Gender:F
Credentials:DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6554 ROBAR TESORA ST
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-8961
Mailing Address - Country:US
Mailing Address - Phone:850-496-8502
Mailing Address - Fax:
Practice Address - Street 1:6554 ROBAR TESORA ST
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:FL
Practice Address - Zip Code:32566-8961
Practice Address - Country:US
Practice Address - Phone:850-496-8502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-05
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3206374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula