Healthcare Provider Details

I. General information

NPI: 1013570035
Provider Name (Legal Business Name): AMAZA TRIPP MSN, APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2019
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 24316
APO AE
09005
US

IV. Provider business mailing address

UNIT 24316
APO AE
09005
US

V. Phone/Fax

Practice location:
  • Phone: 405-209-3991
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number111903
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: