Basic Information
| Provider Information | |||||||||
| NPI: | 1588026728 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAILEY | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | RATLIFF | ||||||||
| NamePrefix: | DR. | ||||||||
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| OtherLastName: | RATLIFF | ||||||||
| OtherFirstName: | AMANDA | ||||||||
| OtherMiddleName: | ANN | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1324 LAKELAND HILLS BLVD | ||||||||
| Address2: | MANAGED CARE DEPT | ||||||||
| City: | LAKELAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8636871100 | ||||||||
| FaxNumber: | 8636306528 | ||||||||
| Practice Location | |||||||||
| Address1: | 3030 HARDEN BLVD | ||||||||
| Address2: | |||||||||
| City: | LAKELAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338037952 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8632845000 | ||||||||
| FaxNumber: | 8632846716 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2016 | ||||||||
| LastUpdateDate: | 08/05/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QS0010X | ME133617 | FL | N | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine | 207Q00000X | ME133617 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.