Individual
AMANDA VICTORIA PUELLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12902 USF MAGNOLIA DR, TAMPA, FL 33612-9416
(813) 745-5739
(813) 449-8002
Mailing address
PO BOX 198441, ATLANTA, GA 30384-8441
(813) 745-7365
(813) 449-8618
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
APRN11018206
FL
363LW0102X
Women's Health Nurse Practitioner
11018206
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
113959100
—
FL
01
—
YL20G
BLUE CROSS BLUE SHIELD
FL
Enumeration date
04/05/2022
Last updated
04/21/2025
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