Individual
AMANDA MAE DISTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
682 E EAGLE AVE, EAGLE LAKE, FL 33839-3238
(440) 417-4482
Mailing address
682 E EAGLE AVE, EAGLE LAKE, FL 33839-3238
(440) 417-4482
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
APRN11046724
FL
Other
Enumeration date
04/16/2026
Last updated
04/16/2026
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