Individual
AMANDA JENE WIRTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
215 IMPERIAL BLVD STE B2, LAKELAND, FL 33803-4689
(813) 684-2229
(813) 413-8507
Mailing address
215 IMPERIAL BLVD STE B2, LAKELAND, FL 33803-4689
(813) 684-2229
(813) 413-8507
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
16289
OH
363LW0102X
Women's Health Nurse Practitioner
Primary
APRN9482070
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0111806
—
OH
05
—
024693700
—
FL
Enumeration date
09/30/2014
Last updated
01/20/2021
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