Individual
AMANDA REGIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12512 BRUCE B DOWNS BLVD, TAMPA, FL 33612-9209
(813) 972-2705
Mailing address
1109 E 139TH AVE, TAMPA, FL 33613-3420
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
FL
Other
Enumeration date
10/05/2016
Last updated
10/05/2016
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