Provider Demographics
NPI:1730493701
Name:PRUETT, AMANDA E (DO)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:E
Last Name:PRUETT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:125 W INDIANTOWN RD STE 103
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-3539
Mailing Address - Country:US
Mailing Address - Phone:561-849-4468
Mailing Address - Fax:561-972-4885
Practice Address - Street 1:125 W INDIANTOWN RD STE 103
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-3539
Practice Address - Country:US
Practice Address - Phone:561-849-4468
Practice Address - Fax:561-972-4885
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-02
Last Update Date:2025-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS14343208D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty