Provider Demographics
NPI:1982000113
Name:O'NEIL, AMANDA MARIE (ARNP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARIE
Last Name:O'NEIL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5129 S LAKELAND DR
Mailing Address - Street 2:UNIT 2
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-2598
Mailing Address - Country:US
Mailing Address - Phone:863-232-4323
Mailing Address - Fax:
Practice Address - Street 1:5129 S LAKELAND DR
Practice Address - Street 2:UNIT 2
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-2598
Practice Address - Country:US
Practice Address - Phone:863-232-4323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-17
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9312760363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily