Healthcare Provider Details

I. General information

NPI: 1982142659
Provider Name (Legal Business Name): DIMPLE AMIN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2017
Last Update Date: 10/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1466 W ELLIOT RD
GILBERT AZ
85233-5186
US

IV. Provider business mailing address

1466 W ELLIOT RD
GILBERT AZ
85233-5186
US

V. Phone/Fax

Practice location:
  • Phone: 480-496-2699
  • Fax: 877-422-3184
Mailing address:
  • Phone: 480-496-2699
  • Fax: 877-422-3184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP9849
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: