Provider Demographics
NPI:1295333102
Name:RUPERT, AMANDA CATHERINE (CNP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:CATHERINE
Last Name:RUPERT
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:CATHERINE
Other - Last Name:MAUDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1289
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33601-1289
Mailing Address - Country:US
Mailing Address - Phone:813-251-0793
Mailing Address - Fax:813-844-1988
Practice Address - Street 1:5 TAMPA GENERAL CIR STE 300
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3578
Practice Address - Country:US
Practice Address - Phone:813-251-0793
Practice Address - Fax:813-844-1988
Is Sole Proprietor?:No
Enumeration Date:2020-10-13
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0027791363LA2100X
FLAPRN11028860363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care