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Individual

AMANDA LYNNE FAGAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
D.O

Contact information

Practice address
4613 S ORANGE BLOSSOM TRL, ORLANDO, FL 32839-1705
(407) 232-9833
(407) 232-9829
Mailing address
4613 S ORANGE BLOSSOM TRL, ORLANDO, FL 32839-1705
(407) 232-9833
(407) 232-9829

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
DO2319
NV
207Q00000X
Family Medicine Physician
Primary
OS17191
FL
207Q00000X
Family Medicine Physician
SL1068
NV

Other

Enumeration date
05/04/2015
Last updated
02/03/2021
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