Provider Demographics
NPI:1871213520
Name:OZYJOWSKI, AMANDA MARIE (TATTOO ARTIST)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARIE
Last Name:OZYJOWSKI
Suffix:
Gender:F
Credentials:TATTOO ARTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 SW PORT ST LUCIE BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34984-5041
Mailing Address - Country:US
Mailing Address - Phone:772-240-5585
Mailing Address - Fax:
Practice Address - Street 1:170 SW PORT ST LUCIE BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34984-5041
Practice Address - Country:US
Practice Address - Phone:772-240-5585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-01
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL56-44-2219209246Z00000X, 246ZA2600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZA2600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherArt, MedicalGroup - Multi-Specialty
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other