Healthcare Provider Details

I. General information

NPI: 1316754534
Provider Name (Legal Business Name): AMANDA SUE NANCE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2024
Last Update Date: 01/16/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3811 E BELL RD STE 111
PHOENIX AZ
85032-2158
US

IV. Provider business mailing address

36608 N SIERRA VISTA DR
SAN TAN VALLEY AZ
85140-9172
US

V. Phone/Fax

Practice location:
  • Phone: 602-675-2585
  • Fax:
Mailing address:
  • Phone: 480-427-9331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF12240268
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: