Wirth, Amanda Jene

Wirth, Amanda Jene is an individual health care provider with primary practice located at 215 Imperial Blvd Ste B2 , Lakeland FL 33803-4689. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Women's Health, which is considered as her primary health care specialty. Wirth, Amanda Jene can be contacted via phone (813) 684-2229.

Contact Information

Primary practice address
215 Imperial Blvd Ste B2 Lakeland FL 33803-4689
Phone: (813) 684-2229
Fax: (813) 413-8507
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Women's Health 363LW0102X 16289 Ohio
Physician Assistants & Advanced Practice Nursing Providers / Women's Health 363LW0102X APRN9482070 Florida

Profile Details

NPI number 1619370053
LBN Legal business name Wirth, Amanda Jene
Credentials Advanced Practice Registered Nurse (APRN)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 30th, 2014
Last updated Jan 20th, 2021 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1619370053 NPPES
Florida MEDICAID 024693700
Florida MEDICAID 0111806

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