Healthcare Provider Details

I. General information

NPI: 1043476971
Provider Name (Legal Business Name): AMANDA APODACA BLANCAS FNP-C, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2008
Last Update Date: 06/03/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 E CAMELBACK RD STE 700
PHOENIX AZ
85016-4245
US

IV. Provider business mailing address

2415 E CAMELBACK RD STE 700
PHOENIX AZ
85016-4245
US

V. Phone/Fax

Practice location:
  • Phone: 888-279-0002
  • Fax: 915-534-1289
Mailing address:
  • Phone: 888-279-0002
  • Fax: 915-534-1289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP116908
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number692637
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number692637
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: