Healthcare Provider Details

I. General information

NPI: 1649104175
Provider Name (Legal Business Name): AMANDA GOULET APRN-RNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28791 N SIERRA ST
SAN TAN VALLEY AZ
85143-6080
US

IV. Provider business mailing address

28791 N SIERRA ST
SAN TAN VALLEY AZ
85143-6080
US

V. Phone/Fax

Practice location:
  • Phone: 480-518-2976
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number224127
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: