Provider Demographics
NPI:1598011314
Name:PERRIN, AMANDA QUIGLEY (RD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:QUIGLEY
Last Name:PERRIN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 ELEUTHERA CT
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32095-9617
Mailing Address - Country:US
Mailing Address - Phone:904-377-6190
Mailing Address - Fax:904-808-4702
Practice Address - Street 1:2820 US 1 S
Practice Address - Street 2:STE J
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-6311
Practice Address - Country:US
Practice Address - Phone:904-377-6190
Practice Address - Fax:904-808-4702
Is Sole Proprietor?:No
Enumeration Date:2012-07-30
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND5445133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLGL320AMedicare Oscar/Certification