Amanda Mae Distin, APRN

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

APRN11046724 Issued in FL

Practice address

1835 Gilmore Ave
Lakeland, FL 33805-3017

Phone

(863) 519-0575

Fax

(863) 582-9251

NPI assigned

Apr 16, 2026

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1776297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788998400000",
    "number": "1487598769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1559",
            "city": "BARTOW",
            "state": "FL",
            "postal_code": "338311559",
            "telephone_number": "863-519-0575",
            "fax_number": "863-582-9251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1835 GILMORE AVE",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338053017",
            "telephone_number": "863-519-0575",
            "fax_number": "863-582-9251"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1255 Golfview Ave",
            "address_purpose": "LOCATION",
            "city": "Bartow",
            "state": "FL",
            "postal_code": "338306736",
            "country_code": "US",
            "telephone_number": "863-519-0575 x6494",
            "fax_number": "863-582-9251",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "213 E Orange St Ste B",
            "address_purpose": "LOCATION",
            "city": "Wauchula",
            "state": "FL",
            "postal_code": "338732934",
            "country_code": "US",
            "telephone_number": "863-519-0575 x6494",
            "fax_number": "863-582-9251",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "715 N Lake Ave Ste 1",
            "address_purpose": "LOCATION",
            "city": "Lakeland",
            "state": "FL",
            "postal_code": "338011908",
            "country_code": "US",
            "telephone_number": "863-519-0575 x6494",
            "fax_number": "863-582-9251",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3750 Emergency Ln Ste 100",
            "address_purpose": "LOCATION",
            "city": "Sebring",
            "state": "FL",
            "postal_code": "338705500",
            "country_code": "US",
            "telephone_number": "863-519-0575 x6494",
            "fax_number": "863-582-9251",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1 Scenic Central Ste 100",
            "address_purpose": "LOCATION",
            "city": "Lake Wales",
            "state": "FL",
            "postal_code": "338536107",
            "country_code": "US",
            "telephone_number": "863-519-0575 x6494",
            "fax_number": "863-582-9251",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DISTIN",
        "first_name": "AMANDA",
        "middle_name": "MAE",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-04-16",
        "last_updated": "2026-09-10",
        "certification_date": "2026-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "FL",
            "license": "APRN11046724",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "132771300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Psychiatric/Mental Health Nurse Practitioner in Lakeland, FL
• Providers in Lakeland, FL by specialty
• Psychiatric/Mental Health Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2026; 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.