Provider Demographics
NPI:1831633692
Name:SELLERS, AMANDA WILLIAMS (ARNP)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:WILLIAMS
Last Name:SELLERS
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 1:1858 MAYO DR
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-4320
Mailing Address - Country:US
Mailing Address - Phone:352-383-5200
Mailing Address - Fax:352-383-3534
Practice Address - Street 1:1858 MAYO DR
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778
Practice Address - Country:US
Practice Address - Phone:352-383-5200
Practice Address - Fax:352-383-3534
Is Sole Proprietor?:No
Enumeration Date:2016-12-13
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9310532363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily