Individual
MRS. AMANDA NICOLE FORMELLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
800 PRUDENTIAL DR, JACKSONVILLE, FL 32207-8211
(352) 502-3945
Mailing address
3848 AUTUMN LEAF CT, JACKSONVILLE, FL 32246-7674
(352) 502-3945
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN9485994
FL
Other
Enumeration date
10/17/2019
Last updated
10/17/2019
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