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Amanda Tippitt

Nurse Practitioner

Physician Assistants & Advanced Practice Nursing Providers

4500 San Pablo Rd S, Jacksonville, FL 32224

(904) 953-2000

PECOS Enrollment

Based on the most recent information from CMS, provider Amanda Tippitt is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 8 days ago.

Profile Details

Provider ID
1053704346
Provider Type
Individual
Full Name
Tippitt, Amanda
Credential
FNP-BC

Gender
Female
Sole Proprietor
No
Enumeration Date
3/10/2015
Last Updated
4/27/2021

Contact Information

Practice Location

4500 San Pablo Rd S, Jacksonville, FL 32224

(904) 953-2000

Unlisted Fax

Mailing Location

4500 San Pablo Rd S, Jacksonville, FL 32224-1865

(904) 953-2000

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363L00000X Primary	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License ARNP9479396 Florida

Amanda Tippitt

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Mazer, Laura S

Koenig, Dayna Margaret Demarco

Hartley, Michel

Perrin, Angela Hartman

Molloy, Sean

Esomonu, Chinenye

Inabinett, Samantha R

Prussak, Karin

Nobles, Daniel

Martin, Angela