Amanda Smith

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

11020706 Issued in FL

Practice address

1338 NW Cavendish CT
Stuart, FL 34994-4085

Phone

(561) 427-5846

NPI assigned

Jul 12, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Amanda O'Connor Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

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

• Banyan Detox, LLC

  • Substance Abuse Rehabilitation Facility
  • Stuart, FL
  • NPI 1407221328
  NPD (past)
• Beachside Detox LLC

  • Substance Abuse Rehabilitation Facility
  • West Palm Beach, FL
  • NPI 1598272098
  NPD (past)

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

{
    "created_epoch": "1657584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703808000000",
    "number": "1942934237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1338 NW CAVENDISH CT",
            "city": "STUART",
            "state": "FL",
            "postal_code": "349944085",
            "telephone_number": "561-427-5846"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1338 NW CAVENDISH CT",
            "city": "STUART",
            "state": "FL",
            "postal_code": "349944085",
            "telephone_number": "561-427-5846"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "AMANDA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-07-12",
        "last_updated": "2023-12-29",
        "certification_date": "2023-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "FL",
            "license": "11020706",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMANDA",
            "last_name": "O'CONNOR",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jacqueline Small, BCBA
• Candace K Smalls
• Kharyisma Mone Smallwood
• Smile Store International, LLC
• Cheryl Lynn Smith McCants
• Angela Smith
• Angelica Smith
• Antonio Smith
• Charsinee Shanique Smith
• Donna J. Smith, AGNP-C

• Psychiatric/Mental Health Nurse Practitioner in Stuart, FL
• Providers in Stuart, 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 Dec 29, 2023; 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.