Individual provider Active NPI

Amanda Marie Tezyk, ARNP

  • Family Nurse Practitioner
  • Fort Myers, FL
National Provider Identifier
1275048290
Registry record updated Jul 31, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
APRN9355879 Issued in FL
Practice address
8260 Gladiolus Dr
Fort Myers, FL 33908-4156
Phone
(239) 437-5755
Fax
(239) 437-5776
NPI assigned
Dec 13, 2017
Last updated
Jul 31, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X APRN9355879 FL Primary

Addresses

Primary practice location

8260 Gladiolus Dr
Fort Myers, FL 33908-4156

Mailing address

4371 Veronica S Shoemaker Blvd
Fort Myers, FL 33916-2216
Phone (239) 274-8200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
APRN9355879FLMDFamily Nurse Practitioner

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1513123200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596153600000",
    "number": "1275048290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4371 VERONICA S SHOEMAKER BLVD",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339162216",
            "telephone_number": "239-274-8200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8260 GLADIOLUS DR",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339084156",
            "telephone_number": "239-437-5755",
            "fax_number": "239-437-5776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TEZYK",
        "first_name": "AMANDA",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-12-13",
        "last_updated": "2020-07-31",
        "certification_date": "2020-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "APRN9355879",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Myers, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.