Individual provider Active NPI

Amanda Lynn Larsen, NP

  • Family Nurse Practitioner
  • Baltimore, MD
National Provider Identifier
1386361772
Registry record updated Oct 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
AC004834 Issued in MD
Practice address
301 Saint Paul PL
Baltimore, MD 21202-2165
Phone
(410) 649-3485
Fax
(410) 659-2817
NPI assigned
Oct 26, 2022
Last updated
Oct 6, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X AC004834 MD Primary
Family Nurse Practitioner 363LF0000X LG-0012199 DE

Addresses

Primary practice location

301 Saint Paul PL
Baltimore, MD 21202-2165

Mailing address

301 Saint Paul PL
Baltimore, MD 21202-2165
Phone (410) 649-3485

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230113002524 MD Practitioner - Nurse Practitioner 7618348467 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Select Physical Therapy Holdings IncGroup PAC ID 9537076401, shared by 76 NPIs, 1,992 clinicians
Tidalhealth Specialty Care LLCGroup PAC ID 7113340845, 375 clinicians

Practice addresses (Care Compare)

1305 S Salisbury Blvd
Suite 5
Salisbury, MD 21801-6845
Phone (667) 253-2323

1630 Woodbrooke Dr
Tidalhealth Neurology
Salisbury, MD 21804-8501
Phone (410) 912-6114

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
82.92 of 100Reported as group
Quality
74.47
Promoting interoperability
92
Improvement activities
40
Cost
75.27

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
LG-0012199DEMDFamily Nurse Practitioner
AC004834MDMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Tidalhealth Specialty Care, LLC CurrentSince Jan 3, 2023 Accepting new patients
Tidalhealth Specialty Care, LLC Past Accepting new patients

Locations

100 E Carroll St
Salisbury, MD 21801
Phone (410) 543-7100

1630 Woodbrooke Dr
Salisbury, MD 21804
Phone (410) 912-6114

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1666742400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1791244800000",
    "number": "1386361772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 SAINT PAUL PL",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212022165",
            "telephone_number": "410-649-3485",
            "fax_number": "410-659-2817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 SAINT PAUL PL",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212022165",
            "telephone_number": "410-649-3485",
            "fax_number": "410-659-2817"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSEN",
        "first_name": "AMANDA",
        "middle_name": "LYNN",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-10-26",
        "last_updated": "2026-10-06",
        "certification_date": "2026-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MD",
            "license": "AC004834",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "DE",
            "license": "LG-0012199",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.