Healthcare Provider Details

I. General information

NPI: 1083133243
Provider Name (Legal Business Name): AMANDA SCARLETT FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2017
Last Update Date: 10/02/2023
Certification Date: 09/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 EAST CAMELBACK ROAD, SUITE 700, ROOM 714
PHOENIX AZ
85016
US

IV. Provider business mailing address

1645 E ROOSEVELT ST
PHOENIX AZ
85006-3638
US

V. Phone/Fax

Practice location:
  • Phone: 866-337-2566
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP10532
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: