Provider Demographics
NPI:1750781167
Name:FILOSI, AMANDA DAWN (ARNP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:DAWN
Last Name:FILOSI
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 1:2624 ATLANTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-3668
Mailing Address - Country:US
Mailing Address - Phone:904-513-3240
Mailing Address - Fax:904-379-2911
Practice Address - Street 1:2624 ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-3668
Practice Address - Country:US
Practice Address - Phone:904-513-3240
Practice Address - Fax:904-379-2911
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-04
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9248442363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016452700Medicaid
FLIE185ZMedicare PIN