Individual
MRS. AMANDA LEE GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
800 PRUDENTIAL DR, JACKSONVILLE, FL 32207-8211
(904) 202-2000
Mailing address
13 BONITA DR, PONTE VEDRA BEACH, FL 32082-2008
(262) 914-5061
Taxonomy
Speciality
Code
Description
License number
State
163WP0200X
Pediatric Registered Nurse
Primary
RN9312579
FL
Other
Enumeration date
09/16/2019
Last updated
09/16/2019
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