Provider Demographics
NPI:1588026728
Name:DAILEY, AMANDA RATLIFF
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:RATLIFF
Last Name:DAILEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:ANN
Other - Last Name:RATLIFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:415 APOLLO BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:APOLLO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33572-2281
Mailing Address - Country:US
Mailing Address - Phone:813-645-8494
Mailing Address - Fax:813-645-0912
Practice Address - Street 1:415 APOLLO BEACH BLVD
Practice Address - Street 2:
Practice Address - City:APOLLO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33572-2281
Practice Address - Country:US
Practice Address - Phone:813-645-8494
Practice Address - Fax:813-645-0912
Is Sole Proprietor?:No
Enumeration Date:2016-03-27
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME133617207QS0010X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine