Provider Demographics
NPI:1891457180
Name:HAYMORE, AMBER LEE (FNP-C)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:LEE
Last Name:HAYMORE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:LEE
Other - Last Name:PROFFITT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN
Mailing Address - Street 1:415 141ST CT NE
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34212-1679
Mailing Address - Country:US
Mailing Address - Phone:941-962-6088
Mailing Address - Fax:
Practice Address - Street 1:4216 CORTEZ RD W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-3121
Practice Address - Country:US
Practice Address - Phone:941-500-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-13
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9477928163WC0200X
FL11016239363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine