Individual provider Active NPI

Amanda L Humphrey, ARNP

  • Family Nurse Practitioner
  • Tampa, FL
National Provider Identifier
1396237400
Registry record updated Dec 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
9435860 Issued in FL
Practice address
302 W Fletcher Ave
Tampa, FL 33612-3415
Phone
(813) 866-0930
NPI assigned
Jun 4, 2018
Last updated
Dec 22, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2021

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 9435860 FL Primary

Addresses

Primary practice location

302 W Fletcher Ave
Tampa, FL 33612-3415

Mailing address

302 W Fletcher Ave
Tampa, FL 33612-3415

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20180912003301 FL Practitioner - Nurse Practitioner 2567712540 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Memon Health Associates, LLCGroup PAC ID 7416257860, 9 clinicians

Practice addresses (Care Compare)

1236 Kingsway Rd
Brandon, FL 33510-2514
Phone (813) 616-8810

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
9435860FLMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Memon Health Associates, LLC CurrentSince May 9, 2024 Accepting new patients

Locations

1236 Kingsway Rd
Brandon, FL 33510
Phone (813) 616-8810

12950 Race Track Rd
Ste 106
Tampa, FL 33626
Phone (813) 616-8810

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/12589/brand/1/csg/1/fhir/r4

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1528070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640131200000",
    "number": "1396237400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "302 W FLETCHER AVE",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336123415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 W FLETCHER AVE",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336123415",
            "telephone_number": "813-866-0930"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUMPHREY",
        "first_name": "AMANDA",
        "middle_name": "L",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-04",
        "last_updated": "2021-12-22",
        "certification_date": "2021-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "9435860",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tampa, FL

Sources for this page

Verify at the official NPI Registry.