Provider Demographics
NPI:1669121190
Name:HAMILTON, AMBER (RD, LD/N)
Entity type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:RD, LD/N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12430 ATTRILL RD APT SUITE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-2308
Mailing Address - Country:US
Mailing Address - Phone:904-465-1314
Mailing Address - Fax:
Practice Address - Street 1:655 SOLOMONS ISLAND RD N
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-3915
Practice Address - Country:US
Practice Address - Phone:904-465-1314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX5597133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered