Provider Demographics
NPI:1639760077
Name:FORDHAM, AMBER
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:FORDHAM
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 1:2078 SCENIC GULF DR LOT 24
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32550-3207
Mailing Address - Country:US
Mailing Address - Phone:804-305-7131
Mailing Address - Fax:
Practice Address - Street 1:2078 SCENIC GULF DR LOT 24
Practice Address - Street 2:
Practice Address - City:MIRAMAR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32550-3207
Practice Address - Country:US
Practice Address - Phone:804-305-7131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care