Individual
AMANDA HIESTAND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
1421 MALABAR RD NE STE 250, PALM BAY, FL 32907-2587
(321) 434-8420
Mailing address
3300 S FISKE BLVD, ROCKLEDGE, FL 32955-4306
(321) 434-8420
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
APRN11007579
FL
363LF0000X
Family Nurse Practitioner
209014032
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
108731900
—
FL
01
—
NC075
MEDICARE HF
FL
Enumeration date
03/10/2016
Last updated
12/14/2020
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